Opioid prodrugs with heterocyclic linkers

ABSTRACT

The embodiments provide prodrug compounds of Formulae I-XV. The present disclosure also provides compositions, and their methods of use, where the compositions comprise a prodrug compound of Formulae I-XV that provides controlled release of an opioid. Such compositions can optionally provide a trypsin inhibitor that interacts with the enzyme that mediates the controlled release of an opioid from the prodrug so as to attenuate enzymatic cleavage of the prodrug.

CROSS REFERENCE TO RELATED APPLICATIONS

The application is a divisional of application Ser. No. 13/415,790 filedMar. 8, 2012, now U.S. Pat. No. 8,685,916 which claims the benefit ofU.S. Provisional Application No. 61/583,516 filed Jan. 5, 2012 and U.S.Provisional Application No. 61/451,010 filed Mar. 9, 2011, which arehereby incorporated by reference in their entireties.

INTRODUCTION

Opioids are susceptible to misuse, abuse, or overdose. Use of and accessto these drugs therefore needs to be controlled. The control of accessto the drugs is expensive to administer and can result in denial oftreatment for patients that are not able to present themselves fordosing. For example, patients suffering from acute pain may be deniedtreatment with an opioid unless they have been admitted to a hospital.Furthermore, control of use is often ineffective, leading to substantialmorbidity and deleterious social consequences.

SUMMARY

This disclosure concerns a prodrug of an opioid that provides controlledrelease of the opioid. Such a prodrug comprises an opioid covalentlyattached to a promoiety. The promoiety comprises an enzyme-cleavablemoiety and a cyclizable spacer leaving group such that the opioidprodrug provides controlled release of opioid via enzyme cleavagefollowed by intramolecular cyclization. The enzyme-mediated release ofthe opioid can occur in the gastrointestinal tract upon oraladministration of the corresponding prodrug. Thus, prodrugs of thedisclosure provide efficient delivery of opioid when ingested.

The present disclosure also provides a composition, such as apharmaceutical composition, that comprises an opioid prodrug of theembodiments. Such a composition can optionally provide an inhibitor thatinteracts with the enzyme that mediates the controlled release of opioidfrom the prodrug so as to attenuate enzymatic cleavage of the prodrug.The disclosure provides for the enzyme being a gastrointestinal (GI)enzyme, such as trypsin. Also provided are methods of use, such as amethod of providing patients with controlled release of opioid using anopioid prodrug of the embodiments.

The embodiments include an opioid prodrug that is a compound of formulaI:

wherein

X is selected from a residue of a ketone-containing opioid, wherein thehydrogen atom of the corresponding hydroxyl group of the enolic tautomerof the ketone is replaced by a covalent bond to —C(O)—N[(Aring)-Y_(c)]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷;a residue of a phenolic opioid, wherein the hydrogen atom of thephenolic hydroxyl group is replaced by a covalent bond to —C(O)—N[(Aring)-Y_(c)]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷;and a residue of an amide-containing opioid, wherein —C(O)—N[(Aring)-Y_(c)]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷is connected to the amide-containing opioid through the oxygen of theamide group, wherein the amide group is converted to an amide enol or animine tautomer;

the A ring is a heterocyclic 5 to 12-membered ring;

each Y is independently selected from alkyl, substituted alkyl, alkenyl,substituted alkenyl, alkynyl, substituted alkynyl, aryl, substitutedaryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl, substitutedalkoxycarbonyl, aminoacyl, substituted aminoacyl, amino, substitutedamino, acylamino, substituted acylamino, and cyano;

c is a number from zero to 3;

each R¹ is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano;

each R² is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano; or

R¹ and R² together with the carbon to which they are attached can form acycloalkyl or substituted cycloalkyl group, or two R¹ or R² groups onadjacent carbon atoms, together with the carbon atoms to which they areattached, can form a cycloalkyl or substituted cycloalkyl group;

a is an integer from one to 8;

provided that when a is one, the A ring is a heterocyclic 6 to12-membered ring; and when the A ring is a heterocyclic 5-membered ring,then a is an integer from 2 to 8;

each R³ is independently hydrogen, alkyl, substituted alkyl, aryl orsubstituted aryl;

R⁵ is selected from hydrogen, alkyl, substituted alkyl, aryl,substituted aryl, arylalkyl, substituted arylalkyl, heteroalkyl,substituted heteroalkyl, heteroaryl, substituted heteroaryl,heteroarylalkyl, and substituted heteroarylalkyl;

each R⁶ is independently selected from hydrogen, alkyl, substitutedalkyl, aryl, substituted aryl, arylalkyl, substituted arylalkyl,heteroalkyl, substituted heteroalkyl, heteroaryl, substitutedheteroaryl, heteroarylalkyl, and substituted heteroarylalkyl;

b is a number from zero to 100; and

R⁷ is selected from hydrogen, alkyl, substituted alkyl, acyl,substituted acyl, alkoxycarbonyl, substituted alkoxycarbonyl, aryl,substituted aryl, arylalkyl, and substituted arylalkyl;

or a salt, hydrate or solvate thereof.

Certain embodiments provide controlled release of ketone-containingopioids. More particularly, the embodiments relate to a prodrug of aketone-containing opioid that provides controlled release of the opioid.Such a prodrug comprises a ketone-containing opioid covalently attachedto a promoiety through the enolic oxygen atom of the ketone-containingopioid. The promoiety comprises an enzyme-cleavable moiety and acyclizable spacer leaving group such that the ketone-modified opioidprodrug provides controlled release of opioid via enzyme cleavagefollowed by intramolecular cyclization. Ketone-modified opioid prodrugsof the disclosure provide efficient delivery of opioid when ingested.The present disclosure also provides a composition, such as apharmaceutical composition, that comprises a ketone-modified opioidprodrug of the embodiments. Also provided are methods of use, such as amethod of providing patients with controlled release ofketone-containing opioid using a ketone-modified opioid prodrug of theembodiments.

The embodiments include a ketone-modified opioid prodrug that is acompound of formula II:

wherein

X represents a residue of a ketone-containing opioid, wherein thehydrogen atom of the corresponding hydroxyl group of the enolic tautomerof the ketone is replaced by a covalent bond to —C(O)—N[(Aring)-Y_(c)]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷;

the A ring is a heterocyclic 5 to 12-membered ring;

each Y is independently selected from alkyl, substituted alkyl, alkenyl,substituted alkenyl, alkynyl, substituted alkynyl, aryl, substitutedaryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl, substitutedalkoxycarbonyl, aminoacyl, substituted aminoacyl, amino, substitutedamino, acylamino, substituted acylamino, and cyano;

c is a number from zero to 3;

each R¹ is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano;

each R² is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano; or

R¹ and R² together with the carbon to which they are attached can form acycloalkyl or substituted cycloalkyl group, or two R¹ or R² groups onadjacent carbon atoms, together with the carbon atoms to which they areattached, can form a cycloalkyl or substituted cycloalkyl group;

a is an integer from one to 8;

provided that when a is one, the A ring is a heterocyclic 6 to12-membered ring; and when the A ring is a heterocyclic 5-membered ring,then a is an integer from 2 to 8;

each R³ is independently hydrogen, alkyl, substituted alkyl, aryl orsubstituted aryl;

R⁵ is selected from hydrogen, alkyl, substituted alkyl, aryl,substituted aryl, arylalkyl, substituted arylalkyl, heteroalkyl,substituted heteroalkyl, heteroaryl, substituted heteroaryl,heteroarylalkyl, and substituted heteroarylalkyl;

each R⁶ is independently selected from hydrogen, alkyl, substitutedalkyl, aryl, substituted aryl, arylalkyl, substituted arylalkyl,heteroalkyl, substituted heteroalkyl, heteroaryl, substitutedheteroaryl, heteroarylalkyl, and substituted heteroarylalkyl;

b is a number from zero to 100; and

R⁷ is selected from hydrogen, alkyl, substituted alkyl, acyl,substituted acyl, alkoxycarbonyl, substituted alkoxycarbonyl, aryl,substituted aryl, arylalkyl, and substituted arylalkyl;

or a salt, hydrate or solvate thereof.

Certain embodiments provide controlled release of phenolic opioids. Moreparticularly, the embodiments relate to a prodrug of a phenolic opioidthat provides controlled release of the opioid. Such a prodrug comprisesa phenolic opioid covalently attached to a promoiety through thephenolic oxygen atom of the phenolic opioid. The promoiety comprises anenzyme-cleavable moiety and a cyclizable spacer leaving group such thatthe phenolic opioid prodrug provides controlled release of opioid viaenzyme cleavage followed by intramolecular cyclization. Phenolic opioidprodrugs of the disclosure provide efficient delivery of opioid wheningested. The present disclosure also provides a composition, such as apharmaceutical composition, that comprises a phenolic opioid prodrug ofthe embodiments. Also provided are methods of use, such as a method ofproviding patients with controlled release of phenolic opioid using aphenolic opioid prodrug of the embodiments.

The embodiments include a phenolic opioid prodrug that is a compound offormula VI:

wherein

X represents a residue of a phenolic opioid, wherein the hydrogen atomof the phenolic hydroxyl group is replaced by a covalent bond to—C(O)—N[(Aring)-Y_(c)]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷;

the A ring is a heterocyclic 5 to 12-membered ring;

each Y is independently selected from alkyl, substituted alkyl, alkenyl,substituted alkenyl, alkynyl, substituted alkynyl, aryl, substitutedaryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl, substitutedalkoxycarbonyl, aminoacyl, substituted aminoacyl, amino, substitutedamino, acylamino, substituted acylamino, and cyano;

c is a number from zero to 3;

each R¹ is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano;

each R² is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano; or

R¹ and R² together with the carbon to which they are attached can form acycloalkyl or substituted cycloalkyl group, or two R¹ or R² groups onadjacent carbon atoms, together with the carbon atoms to which they areattached, can form a cycloalkyl or substituted cycloalkyl group;

a is an integer from one to 8;

provided that when a is one, the A ring is a heterocyclic 6 to12-membered ring; and when the A ring is a heterocyclic 5-membered ring,then a is an integer from 2 to 8;

each R³ is independently hydrogen, alkyl, substituted alkyl, aryl orsubstituted aryl;

R⁵ is selected from hydrogen, alkyl, substituted alkyl, aryl,substituted aryl, arylalkyl, substituted arylalkyl, heteroalkyl,substituted heteroalkyl, heteroaryl, substituted heteroaryl,heteroarylalkyl, and substituted heteroarylalkyl;

each R⁶ is independently selected from hydrogen, alkyl, substitutedalkyl, aryl, substituted aryl, arylalkyl, substituted arylalkyl,heteroalkyl, substituted heteroalkyl, heteroaryl, substitutedheteroaryl, heteroarylalkyl, and substituted heteroarylalkyl;

b is a number from zero to 100;

R⁷ is selected from hydrogen, alkyl, substituted alkyl, acyl,substituted acyl, alkoxycarbonyl, substituted alkoxycarbonyl, aryl,substituted aryl, arylalkyl, and substituted arylalkyl;

or a salt, hydrate or solvate thereof.

Certain embodiments provide controlled release of amide-containingopioids. More particularly, the embodiments relate to a prodrug of anamide-containing opioid that provides controlled release of the opioid.Such a prodrug comprises an amide-containing opioid covalently attachedto a promoiety through the enolic oxygen atom of the amide enol moietyor through the oxygen of the imine tautomer of the amide-containingopioid. The promoiety comprises an enzyme-cleavable moiety and acyclizable spacer leaving group such that the amide-modified opioidprodrug provides controlled release of opioid via enzyme cleavagefollowed by intramolecular cyclization. Amide-modified opioid prodrugsof the disclosure provide efficient delivery of opioid when ingested.The present disclosure also provides a composition, such as apharmaceutical composition, that comprises an amide-modified opioidprodrug of the embodiments. Also provided are methods of use, such as amethod of providing patients with controlled release of amide-containingopioid using an amide-modified opioid prodrug of the embodiments.

The embodiments include an amide containing opioid prodrug that is acompound of formula X:

wherein

X represents a residue of an amide-containing opioid, wherein —C(O)—N[(Aring)-Y_(c)]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷is connected to the amide-containing opioid through the oxygen of theamide group, wherein the amide group is converted to an amide enol or animine tautomer;

the A ring is a heterocyclic 5 to 12-membered ring;

each Y is independently selected from alkyl, substituted alkyl, alkenyl,substituted alkenyl, alkynyl, substituted alkynyl, aryl, substitutedaryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl, substitutedalkoxycarbonyl, aminoacyl, substituted aminoacyl, amino, substitutedamino, acylamino, substituted acylamino, and cyano;

c is a number from zero to 3;

each R¹ is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano;

each R² is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano; or

R¹ and R² together with the carbon to which they are attached can form acycloalkyl or substituted cycloalkyl group, or two R¹ or R² groups onadjacent carbon atoms, together with the carbon atoms to which they areattached, can form a cycloalkyl or substituted cycloalkyl group;

a is an integer from one to 8;

provided that when a is one, the A ring is a heterocyclic 6 to12-membered ring; and when the A ring is a heterocyclic 5-membered ring,then a is an integer from 2 to 8;

each R³ is independently hydrogen, alkyl, substituted alkyl, aryl orsubstituted aryl;

R⁵ is selected from hydrogen, alkyl, substituted alkyl, aryl,substituted aryl, arylalkyl, substituted arylalkyl, heteroalkyl,substituted heteroalkyl, heteroaryl, substituted heteroaryl,heteroarylalkyl, and substituted heteroarylalkyl;

each R⁶ is independently selected from hydrogen, alkyl, substitutedalkyl, aryl, substituted aryl, arylalkyl, substituted arylalkyl,heteroalkyl, substituted heteroalkyl, heteroaryl, substitutedheteroaryl, heteroarylalkyl, and substituted heteroarylalkyl;

b is a number from zero to 100;

R⁷ is selected from hydrogen, alkyl, substituted alkyl, acyl,substituted acyl, alkoxycarbonyl, substituted alkoxycarbonyl, aryl,substituted aryl, arylalkyl, and substituted arylalkyl;

or a salt, hydrate or solvate thereof.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 is a schematic representing the effect of increasing the level ofa GI enzyme inhibitor (“inhibitor”, X axis) on a PK parameter (e.g.,drug Cmax) (Y axis) for a fixed dose of prodrug. The effect of inhibitorupon a prodrug PK parameter can range from undetectable, to moderate, tocomplete inhibition (i.e., no detectable drug release).

FIG. 2 provides schematics of drug concentration in plasma (Y axis) overtime (X axis). Panel A is a schematic of a pharmacokinetic (PK) profilefollowing ingestion of prodrug with a GI enzyme inhibitor (dashed line)where the drug Cmax is modified relative to that of prodrug withoutinhibitor (solid line). Panel B is a schematic of a PK profile followingingestion of prodrug with inhibitor (dashed line) where drug Cmax anddrug Tmax are modified relative to that of prodrug without inhibitor(solid line). Panel C is a schematic of a PK profile following ingestionof prodrug with inhibitor (dashed line) where drug Tmax is modifiedrelative to that of prodrug without inhibitor (solid line).

FIG. 3 provides schematics representing differential concentration-dosePK profiles that can result from the dosing of multiples of a dose unit(X axis) of the present disclosure. Different PK profiles (asexemplified herein for a representative PK parameter, drug Cmax (Yaxis)) can be provided by adjusting the relative amount of prodrug andGI enzyme inhibitor contained in a single dose unit or by using adifferent prodrug or inhibitor in the dose unit.

FIG. 4 compares mean plasma concentrations over time of oxycodonerelease following PO administration to rats of several ketone-modifiedopioid prodrugs of the embodiments.

FIG. 5A compares mean plasma concentrations over time of oxycodonerelease following PO administration to dogs of several ketone-modifiedopioid prodrugs of the embodiments. FIG. 5B compares mean plasmaconcentrations over time of oxycodone release following POadministration to dogs of ketone-modified opioid prodrug Compound KC-17of the embodiments, oxycodone prodrug Compound KC-3, OxyContin® tablets,or oxycodone HCl.

FIG. 6A compares mean plasma concentrations over time of oxycodonerelease following PO administration to rats of increasing doses ofketone-modified opioid prodrug Compound KC-12. FIG. 6B compares meanplasma concentrations over time of oxycodone release following POadministration to rats of increasing doses of ketone-modified opioidprodrug Compound KC-17.

FIG. 7A compares mean plasma concentrations over time of oxycodonerelease following PO administration to rats of ketone-modified opioidprodrug Compound KC-12 co-dosed with increasing amounts of trypsininhibitor Compound 109. FIG. 7B and FIG. 7C compare mean plasmaconcentrations over time of oxycodone release following POadministration to rats of two doses of ketone-modified opioid prodrugCompound KC-17, each co-dosed with increasing amounts of trypsininhibitor Compound 109.

FIG. 8 compares mean plasma concentrations over time of tapentadolrelease following PO administration to rats of phenolic opioid prodrugCompound TP-5 in the absence or presence of a co-dose of trypsininhibitor Compound 109.

FIG. 9 compares mean plasma concentrations over time of hydrocodonerelease following PO administration to rats of increasing doses ofketone-modified opioid prodrug Compound KC-31.

FIG. 10 compares mean plasma concentrations over time of hydrocodonerelease following PO administration to rats of hydrocodone and POadministration to rats of hydrocodone prodrugs Compound KC-32, CompoundKC-35, Compound KC-36, and Compound KC-37.

FIG. 11 compares mean plasma concentrations over time of hydrocodonerelease following PO administration to rats of hydrocodone and POadministration to rats of hydrocodone prodrugs Compound KC-38 andCompound KC-39.

FIG. 12 compares mean plasma concentrations over time of hydrocodonerelease following PO administration to rats of hydrocodone and POadministration to rats of hydrocodone prodrugs Compound KC-40, CompoundKC-47, and Compound KC-50.

FIG. 13A compares mean plasma concentrations over time of hydrocodonerelease following PO administration to rats of prodrug Compound KC-40with increasing amounts of co-dosed trypsin inhibitor Compound 109. FIG.13B compares mean plasma concentrations over time of hydrocodone releasefollowing PO administration to rats of prodrug Compound KC-40 withincreasing amounts of co-dosed trypsin inhibitor Compound 109 tohydrocodone values expected from a normalized hydrocodone dose. FIG. 13Ccompares the mean plasma concentrations over time of hydrocodone releasefollowing PO administration to rats of prodrug Compound KC-50 withincreasing amounts of co-dosed trypsin inhibitor Compound 109. FIG. 13Dcompares mean plasma concentrations over time of hydrocodone releasefollowing PO administration to rats of prodrug Compound KC-50 withincreasing amounts of co-dosed trypsin inhibitor Compound 109 tohydrocodone values expected from a normalized hydrocodone dose.

FIG. 14A compares mean plasma concentrations over time of hydrocodonefollowing PO administration to dogs of hydrocodone and PO administrationto dogs of increasing amounts of prodrug Compound KC-40. FIG. 14B, FIGS.14C and 14D each compares mean plasma concentrations over time ofhydrocodone following PO administration to dogs of, respectively, 1, 4or 10 dose units comprising prodrug Compound KC-40 and trypsin inhibitorCompound 109 to plasma concentrations of hydrocodone following POadministered to dogs of 1 dose equivalent of hydrocodone or predictedconcentrations for 4 or 10 dose equivalents of hydrocodone,respectively.

FIG. 15A compares mean plasma concentrations over time of hydrocodonefollowing PO administration to dogs of hydrocodone and PO administrationto dogs of increasing amounts of prodrug Compound KC-50. FIG. 15B andFIG. 15C compare mean plasma concentrations over time of hydrocodonefollowing PO administration to dogs of hydrocodone to plasmaconcentrations over time of hydrocodone following PO administration todogs of the indicated doses of prodrug Compound KC-50 with or withouttrypsin inhibitor Compound 109.

FIG. 16 compares mean plasma concentrations over time of oxycodonerelease following PO administration to rats of oxycodone prodrugCompound KC-55 or oxycodone.

FIG. 17A provides oxycodone exposure results for rats orallyadministered prodrug Compound KC-55 alone or co-dosed with trypsininhibitor Compound 109. FIG. 17B provides oxycodone exposure results forrats orally administered prodrug Compound KC-55 alone or co-dosed withtrypsin inhibitor Compound 109.

TERMS

The following terms have the following meaning unless otherwiseindicated. Any undefined terms have their art recognized meanings.

“Alkyl” by itself or as part of another substituent refers to asaturated branched or straight-chain monovalent hydrocarbon radicalderived by the removal of one hydrogen atom from a single carbon atom ofa parent alkane. Typical alkyl groups include, but are not limited to,methyl; ethyl, propyls such as propan-1-yl or propan-2-yl; and butylssuch as butan-1-yl, butan-2-yl, 2-methyl-propan-1-yl or2-methyl-propan-2-yl. In some embodiments, an alkyl group comprises from1 to 20 carbon atoms. In other embodiments, an alkyl group comprisesfrom 1 to 10 carbon atoms. In still other embodiments, an alkyl groupcomprises from 1 to 6 carbon atoms, such as from 1 to 4 carbon atoms.

“Alkanyl” by itself or as part of another substituent refers to asaturated branched, straight-chain or cyclic alkyl radical derived bythe removal of one hydrogen atom from a single carbon atom of an alkane.Typical alkanyl groups include, but are not limited to, methanyl;ethanyl; propanyls such as propan-1-yl, propan-2-yl (isopropyl),cyclopropan-1-yl, etc.; butanyls such as butan-1-yl, butan-2-yl(sec-butyl), 2-methyl-propan-1-yl (isobutyl), 2-methyl-propan-2-yl(t-butyl), cyclobutan-1-yl, etc.; and the like.

“Alkylene” refers to a branched or unbranched saturated hydrocarbonchain, usually having from 1 to 40 carbon atoms, more usually 1 to 10carbon atoms and even more usually 1 to 6 carbon atoms. This term isexemplified by groups such as methylene (—CH₂—), ethylene (—CH₂CH₂—),the propylene isomers (e.g., —CH₂CH₂CH₂— and —CH(CH₃)CH₂—) and the like.

“Alkenyl” by itself or as part of another substituent refers to anunsaturated branched, straight-chain or cyclic alkyl radical having atleast one carbon-carbon double bond derived by the removal of onehydrogen atom from a single carbon atom of an alkene. The group may bein either the cis or trans conformation about the double bond(s).Typical alkenyl groups include, but are not limited to, ethenyl;propenyls such as prop-1-en-1-yl, prop-1-en-2-yl, prop-2-en-1-yl(allyl), prop-2-en-2-yl, cycloprop-1-en-1-yl; cycloprop-2-en-1-yl;butenyls such as but-1-en-1-yl, but-1-en-2-yl, 2-methyl-prop-1-en-1-yl,but-2-en-1-yl, but-2-en-1-yl, but-2-en-2-yl, buta-1,3-dien-1-yl,buta-1,3-dien-2-yl, cyclobut-1-en-1-yl, cyclobut-1-en-3-yl,cyclobuta-1,3-dien-1-yl, etc.; and the like.

“Alkynyl” by itself or as part of another substituent refers to anunsaturated branched, straight-chain or cyclic alkyl radical having atleast one carbon-carbon triple bond derived by the removal of onehydrogen atom from a single carbon atom of an alkyne. Typical alkynylgroups include, but are not limited to, ethynyl; propynyls such asprop-1-yn-1-yl, prop-2-yn-1-yl, etc.; butynyls such as but-1-yn-1-yl,but-1-yn-3-yl, but-3-yn-1-yl, etc.; and the like.

“Acyl” by itself or as part of another substituent refers to a radical—C(O)R³⁰, where R³⁰ is hydrogen, alkyl, cycloalkyl, cycloheteroalkyl,aryl, arylalkyl, heteroalkyl, heteroaryl, heteroarylalkyl as definedherein and substituted versions thereof. Representative examplesinclude, but are not limited to formyl, acetyl, cyclohexylcarbonyl,cyclohexylmethylcarbonyl, benzoyl, benzylcarbonyl, piperonyl, succinyl,and malonyl, and the like.

“Acylamino” refers to the groups —NR²⁰C(O)alkyl, —NR²⁰C(O)substitutedalkyl, NR²⁰C(O)cycloalkyl, —NR²⁰C(O)substituted cycloalkyl,—NR²⁰C(O)cycloalkenyl, —NR²⁰C(O)substituted cycloalkenyl,—NR²⁰C(O)alkenyl, —NR²⁰C(O)substituted alkenyl, —NR²⁰C(O)alkynyl,—NR²⁰C(O)substituted alkynyl, —NR²⁰C(O)aryl, —NR²⁰C(O)substituted aryl,—NR²⁰C(O)heteroaryl, —NR²⁰C(O)substituted heteroaryl,—NR²⁰C(O)heterocyclic, and —NR²⁰C(O)substituted heterocyclic, whereinR²⁰ is hydrogen or alkyl and wherein alkyl, substituted alkyl, alkenyl,substituted alkenyl, alkynyl, substituted alkynyl, cycloalkyl,substituted cycloalkyl, cycloalkenyl, substituted cycloalkenyl, aryl,substituted aryl, heteroaryl, substituted heteroaryl, heterocyclic, andsubstituted heterocyclic are as defined herein.

“Amino” refers to the group —NH₂.

“Substituted amino” refers to the group —NRR where each R isindependently selected from the group consisting of hydrogen, alkyl,substituted alkyl, cycloalkyl, substituted cycloalkyl, alkenyl,substituted alkenyl, cycloalkenyl, substituted cycloalkenyl, alkynyl,substituted alkynyl, aryl, heteroaryl, and heterocyclyl provided that atleast one R is not hydrogen.

“Aminoacyl” refers to the group —C(O)NR²¹R²², wherein R²¹ and R²²independently are selected from the group consisting of hydrogen, alkyl,substituted alkyl, alkenyl, substituted alkenyl, alkynyl, substitutedalkynyl, aryl, substituted aryl, cycloalkyl, substituted cycloalkyl,cycloalkenyl, substituted cycloalkenyl, heteroaryl, substitutedheteroaryl, heterocyclic, and substituted heterocyclic and where R²¹ andR²² are optionally joined together with the nitrogen bound thereto toform a heterocyclic or substituted heterocyclic group, and whereinalkyl, substituted alkyl, alkenyl, substituted alkenyl, alkynyl,substituted alkynyl, cycloalkyl, substituted cycloalkyl, cycloalkenyl,substituted cycloalkenyl, aryl, substituted aryl, heteroaryl,substituted heteroaryl, heterocyclic, and substituted heterocyclic areas defined herein.

“Alkoxy” by itself or as part of another substituent refers to a radical—OR³¹ where R³¹ represents an alkyl or cycloalkyl group as definedherein. Representative examples include, but are not limited to,methoxy, ethoxy, propoxy, butoxy, cyclohexyloxy and the like.

“Alkoxycarbonyl” by itself or as part of another substituent refers to aradical —C(O)OR³¹ where R³¹ represents an alkyl or cycloalkyl group asdefined herein. Representative examples include, but are not limited to,methoxycarbonyl, ethoxycarbonyl, propoxycarbonyl, butoxycarbonyl,cyclohexyloxycarbonyl and the like.

“Aryl” by itself or as part of another substituent refers to amonovalent aromatic hydrocarbon radical derived by the removal of onehydrogen atom from a single carbon atom of an aromatic ring system.Typical aryl groups include, but are not limited to, groups derived fromaceanthrylene, acenaphthylene, acephenanthrylene, anthracene, azulene,benzene, chrysene, coronene, fluoranthene, fluorene, hexacene,hexaphene, hexylene, as-indacene, s-indacene, indane, indene,naphthalene, octacene, octaphene, octalene, ovalene, penta-2,4-diene,pentacene, pentalene, pentaphene, perylene, phenalene, phenanthrene,picene, pleiadene, pyrene, pyranthrene, rubicene, triphenylene,trinaphthalene and the like. In certain embodiments, an aryl groupcomprises from 6 to 20 carbon atoms. In certain embodiments, an arylgroup comprises from 6 to 12 carbon atoms. Examples of an aryl group arephenyl and naphthyl.

“Arylalkyl” by itself or as part of another substituent refers to anacyclic alkyl radical in which one of the hydrogen atoms bonded to acarbon atom, typically a terminal or sp³ carbon atom, is replaced withan aryl group. Typical arylalkyl groups include, but are not limited to,benzyl, 2-phenylethan-1-yl, 2-phenylethen-1-yl, naphthylmethyl,2-naphthylethan-1-yl, 2-naphthylethen-1-yl, naphthobenzyl,2-naphthophenylethan-1-yl and the like. Where specific alkyl moietiesare intended, the nomenclature arylalkanyl, arylalkenyl and/orarylalkynyl is used. In certain embodiments, an arylalkyl group is(C₇-C₃₀) arylalkyl, e.g., the alkanyl, alkenyl or alkynyl moiety of thearylalkyl group is (C₁-C₁₀) and the aryl moiety is (C₆-C₂₀). In certainembodiments, an arylalkyl group is (C₇-C₂₀) arylalkyl, e.g., thealkanyl, alkenyl or alkynyl moiety of the arylalkyl group is (C₁-C₈) andthe aryl moiety is (C₆-C₁₂).

“Arylaryl” by itself or as part of another substituent, refers to amonovalent hydrocarbon group derived by the removal of one hydrogen atomfrom a single carbon atom of a ring system in which two or moreidentical or non-identical aromatic ring systems are joined directlytogether by a single bond, where the number of such direct ringjunctions is one less than the number of aromatic ring systems involved.Typical arylaryl groups include, but are not limited to, biphenyl,triphenyl, phenyl-napthyl, binaphthyl, biphenyl-napthyl, and the like.When the number of carbon atoms in an arylaryl group is specified, thenumbers refer to the carbon atoms comprising each aromatic ring. Forexample, (C₅-C₁₄) arylaryl is an arylaryl group in which each aromaticring comprises from 5 to 14 carbons, e.g., biphenyl, triphenyl,binaphthyl, phenylnapthyl, etc. In certain embodiments, each aromaticring system of an arylaryl group is independently a (C₅-C₁₄) aromatic.In certain embodiments, each aromatic ring system of an arylaryl groupis independently a (C₅-C₁₀) aromatic. In certain embodiments, eacharomatic ring system is identical, e.g., biphenyl, triphenyl,binaphthyl, trinaphthyl, etc.

“Carboxyl,” “carboxy” or “carboxylate” refers to —CO₂H or salts thereof.

“Cyano” or “nitrile” refers to the group —CN.

“Cycloalkyl” by itself or as part of another substituent refers to asaturated or unsaturated cyclic alkyl radical. Where a specific level ofsaturation is intended, the nomenclature “cycloalkanyl” or“cycloalkenyl” is used. Typical cycloalkyl groups include, but are notlimited to, groups derived from cyclopropane, cyclobutane, cyclopentane,cyclohexane and the like. In certain embodiments, the cycloalkyl groupis (C₃-C₁₀) cycloalkyl. In certain embodiments, the cycloalkyl group is(C₃-C₇) cycloalkyl.

“Cycloheteroalkyl” or “heterocyclyl” by itself or as part of anothersubstituent, refers to a saturated or unsaturated cyclic alkyl radicalin which one or more carbon atoms (and any associated hydrogen atoms)are independently replaced with the same or different heteroatom.Typical heteroatoms to replace the carbon atom(s) include, but are notlimited to, N, P, O, S, Si, etc. Where a specific level of saturation isintended, the nomenclature “cycloheteroalkanyl” or “cycloheteroalkenyl”is used. Typical cycloheteroalkyl groups include, but are not limitedto, groups derived from epoxides, azirines, thiiranes, imidazolidine,morpholine, piperazine, piperidine, pyrazolidine, pyrrolidine,quinuclidine and the like.

“Heteroalkyl, Heteroalkanyl, Heteroalkenyl and Heteroalkynyl” bythemselves or as part of another substituent refer to alkyl, alkanyl,alkenyl and alkynyl groups, respectively, in which one or more of thecarbon atoms (and any associated hydrogen atoms) are independentlyreplaced with the same or different heteroatomic groups. Typicalheteroatomic groups which can be included in these groups include, butare not limited to, —O—, —S—, —S—S—, —O—S—, —NR³⁷R³⁸—, ═N—N═, —N═N—,—N═N—NR³⁹R⁴⁰, —PR⁴¹—, —P(O)₂—, —POR⁴²—, —O—P(O)₂—, —S—O—, —S—(O)—,—SO₂—, —SnR⁴³R⁴⁴— and the like, where R³⁷, R³⁸, R³⁹, R⁴⁰, R⁴¹, R⁴², R⁴³and R⁴⁴ are independently hydrogen, alkyl, substituted alkyl, aryl,substituted aryl, arylalkyl, substituted arylalkyl, cycloalkyl,substituted cycloalkyl, cycloheteroalkyl, substituted cycloheteroalkyl,heteroalkyl, substituted heteroalkyl, heteroaryl, substitutedheteroaryl, heteroarylalkyl or substituted heteroarylalkyl.

“Heteroaryl” by itself or as part of another substituent, refers to amonovalent heteroaromatic radical derived by the removal of one hydrogenatom from a single atom of a heteroaromatic ring system. Typicalheteroaryl groups include, but are not limited to, groups derived fromacridine, arsindole, carbazole, β-carboline, chromane, chromene,cinnoline, furan, imidazole, indazole, indole, indoline, indolizine,isobenzofuran, isochromene, isoindole, isoindoline, isoquinoline,isothiazole, isoxazole, naphthyridine, oxadiazole, oxazole, perimidine,phenanthridine, phenanthroline, phenazine, phthalazine, pteridine,purine, pyran, pyrazine, pyrazole, pyridazine, pyridine, pyrimidine,pyrrole, pyrrolizine, quinazoline, quinoline, quinolizine, quinoxaline,tetrazole, thiadiazole, thiazole, thiophene, triazole, xanthene,benzodioxole and the like. In certain embodiments, the heteroaryl groupis from 5-20 membered heteroaryl. In certain embodiments, the heteroarylgroup is from 5-10 membered heteroaryl. In certain embodiments,heteroaryl groups are those derived from thiophene, pyrrole,benzothiophene, benzofuran, indole, pyridine, quinoline, imidazole,oxazole and pyrazine.

“Heteroarylalkyl” by itself or as part of another substituent, refers toan acyclic alkyl radical in which one of the hydrogen atoms bonded to acarbon atom, typically a terminal or sp³ carbon atom, is replaced with aheteroaryl group. Where specific alkyl moieties are intended, thenomenclature heteroarylalkanyl, heteroarylalkenyl and/orheteroarylalkynyl is used. In certain embodiments, the heteroarylalkylgroup is a 6-30 membered heteroarylalkyl, e.g., the alkanyl, alkenyl oralkynyl moiety of the heteroarylalkyl is 1-10 membered and theheteroaryl moiety is a 5-20-membered heteroaryl. In certain embodiments,the heteroarylalkyl group is 6-20 membered heteroarylalkyl, e.g., thealkanyl, alkenyl or alkynyl moiety of the heteroarylalkyl is 1-8membered and the heteroaryl moiety is a 5-12-membered heteroaryl.

“Heterocycle,” “heterocyclic,” “heterocycloalkyl,” and “heterocyclyl”refer to a saturated or unsaturated group having a single ring ormultiple condensed rings, including fused bridged and spiro ringsystems, and having from 3 to 15 ring atoms, including 1 to 4 heteroatoms. These hetero atoms are selected from the group consisting ofnitrogen, sulfur, or oxygen, wherein, in fused ring systems, one or moreof the rings can be cycloalkyl, aryl, or heteroaryl, provided that thepoint of attachment is through the non-aromatic ring. In certainembodiments, the nitrogen and/or sulfur atom(s) of the heterocyclicgroup are optionally oxidized to provide for the N-oxide, —S(O)—, or—SO₂— moieties.

“Aromatic Ring System” by itself or as part of another substituent,refers to an unsaturated cyclic or polycyclic ring system having aconjugated π electron system. Specifically included within thedefinition of “aromatic ring system” are fused ring systems in which oneor more of the rings are aromatic and one or more of the rings aresaturated or unsaturated, such as, for example, fluorene, indane,indene, phenalene, etc. Typical aromatic ring systems include, but arenot limited to, aceanthrylene, acenaphthylene, acephenanthrylene,anthracene, azulene, benzene, chrysene, coronene, fluoranthene,fluorene, hexacene, hexaphene, hexylene, as-indacene, s-indacene,indane, indene, naphthalene, octacene, octaphene, octalene, ovalene,penta-2,4-diene, pentacene, pentalene, pentaphene, perylene, phenalene,phenanthrene, picene, pleiadene, pyrene, pyranthrene, rubicene,triphenylene, trinaphthalene and the like.

“Heteroaromatic Ring System” by itself or as part of anothersubstituent, refers to an aromatic ring system in which one or morecarbon atoms (and any associated hydrogen atoms) are independentlyreplaced with the same or different heteroatom. Typical heteroatoms toreplace the carbon atoms include, but are not limited to, N, P, O, S,Si, etc. Specifically included within the definition of “heteroaromaticring systems” are fused ring systems in which one or more of the ringsare aromatic and one or more of the rings are saturated or unsaturated,such as, for example, arsindole, benzodioxan, benzofuran, chromane,chromene, indole, indoline, xanthene, etc. Typical heteroaromatic ringsystems include, but are not limited to, arsindole, carbazole,β-carboline, chromane, chromene, cinnoline, furan, imidazole, indazole,indole, indoline, indolizine, isobenzofuran, isochromene, isoindole,isoindoline, isoquinoline, isothiazole, isoxazole, naphthyridine,oxadiazole, oxazole, perimidine, phenanthridine, phenanthroline,phenazine, phthalazine, pteridine, purine, pyran, pyrazine, pyrazole,pyridazine, pyridine, pyrimidine, pyrrole, pyrrolizine, quinazoline,quinoline, quinolizine, quinoxaline, tetrazole, thiadiazole, thiazole,thiophene, triazole, xanthene and the like.

“Substituted” refers to a group in which one or more hydrogen atoms areindependently replaced with the same or different substituent(s).Typical substituents include, but are not limited to, alkylenedioxy(such as methylenedioxy), -M, —R⁶⁰, —O⁻, ═O, —OR⁶⁰, —SR⁶⁰, —S⁻, ═S,—NR⁶⁰R⁶¹, ═NR⁶⁰, —CF₃, —CN, —OCN, —SCN, —NO, —NO₂, ═N₂, —N₃, —S(O)₂O⁻,—S(O)₂OH, —S(O)₂R⁶⁰, —OS(O)₂O⁻, —OS(O)₂R⁶⁰, —P(O)(O⁻)₂, —P(O)(OR⁶⁰)(O⁻),—OP(O)(OR⁶⁰)(OR⁶¹), —C(O)R⁶⁰, —C(S)R⁶⁰, —C(O)OR⁶⁰, —C(O)NR⁶⁰R⁶¹,—C(O)O⁻, —C(S)OR⁶⁰, —NR⁶²C(O)NR⁶⁰R⁶¹, —NR⁶²C(S)NR⁶⁰R⁶¹,—NR⁶²C(NR⁶³)NR⁶⁰R⁶¹ and —C(NR⁶²)NR⁶⁰R⁶¹ where M is halogen; R⁶⁰, R⁶¹,R⁶² and R⁶³ are independently hydrogen, alkyl, substituted alkyl,alkoxy, substituted alkoxy, cycloalkyl, substituted cycloalkyl,cycloheteroalkyl, substituted cycloheteroalkyl, aryl, substituted aryl,heteroaryl or substituted heteroaryl, or optionally R⁶⁰ and R⁶¹ togetherwith the nitrogen atom to which they are bonded form a cycloheteroalkylor substituted cycloheteroalkyl ring; and R⁶⁴ and R⁶⁵ are independentlyhydrogen, alkyl, substituted alkyl, aryl, cycloalkyl, substitutedcycloalkyl, cycloheteroalkyl, substituted cycloheteroalkyl, aryl,substituted aryl, heteroaryl or substituted heteroaryl, or optionallyR⁶⁴ and R⁶⁵ together with the nitrogen atom to which they are bondedform a cycloheteroalkyl or substituted cycloheteroalkyl ring. In certainembodiments, substituents include -M, —R⁶⁰═O, —OR⁶⁰, —SR⁶⁰, —S⁻, ═S,—NR⁶⁰R⁶¹, ═NR⁶⁰, —CF₃, —CN, —OCN, —SCN, —NO, —NO₂, ═N₂, —N₃, —S(O)₂R⁶⁰,—OS(O)₂O⁻, —OS(O)₂R⁶⁰, —P(O)(O⁻)₂, —P(O)(OR⁶⁰)(O⁻), —OP(O)(OR⁶⁰)(OR⁶¹),—C(O)R⁶⁰, —C(S)R⁶⁰, —C(O)OR⁶⁰, —C(O)NR⁶⁰R⁶¹, —C(O)O⁻, —NR⁶²C(O)NR⁶⁰R⁶¹.In certain embodiments, substituents include -M, —R⁶⁰,

═O, —OR⁶⁰, —SR⁶⁰, —NR⁶⁰R⁶¹, —CF₃, —CN, —NO₂, —S(O)₂R⁶⁰, —P(O)(OR⁶⁰)(O⁻),—OP(O)(OR⁶⁰)(OR⁶¹), —C(O)R⁶⁰, —C(O)OR⁶⁰, —C(O)NR⁶⁰R⁶¹, —C(O)O⁻. Incertain embodiments, substituents include -M, —R⁶⁰,

═O, —OR⁶⁰, —SR⁶⁰, —NR⁶⁰R⁶¹, —CF₃, —CN, —NO₂, —S(O)₂R⁶⁰,—OP(O)(OR⁶⁰)(OR⁶¹), —C(O)R⁶⁰, —C(O)OR⁶⁰, —C(O)O⁻, where R⁶⁰, R⁶¹ and R⁶²are as defined above. For example, a substituted group may bear amethylenedioxy substituent or one, two, or three substituents selectedfrom a halogen atom, a (1-4C)alkyl group and a (1-4C)alkoxy group.

It is understood that in all substituted groups defined above, polymersarrived at by defining substituents with further substituents tothemselves (e.g., substituted aryl having a substituted aryl group as asubstituent which is itself substituted with a substituted aryl group,which is further substituted by a substituted aryl group, etc.) are notintended for inclusion herein. In such cases, the maximum number of suchsubstitutions is three. For example, serial substitutions of substitutedaryl groups are limited to substituted aryl-(substitutedaryl)-substituted aryl.

As to any of the groups disclosed herein which contain one or moresubstituents, it is understood, of course, that such groups do notcontain any substitution or substitution patterns which are stericallyimpractical and/or synthetically non-feasible. In addition, the subjectcompounds include all stereochemical isomers arising from thesubstitution of these compounds.

Unless indicated otherwise, the nomenclature of substituents that arenot explicitly defined herein are arrived at by naming the terminalportion of the functionality followed by the adjacent functionalitytoward the point of attachment. For example, the substituent“arylalkyloxycarbonyl” refers to the group (aryl)-(alkyl)-O—C(O)—.

“Dose unit” as used herein refers to a combination of a GIenzyme-cleavable prodrug (e.g., trypsin-cleavable prodrug) and a GIenzyme inhibitor (e.g., a trypsin inhibitor). A “single dose unit” is asingle unit of a combination of a GI enzyme-cleavable prodrug (e.g.,trypsin-cleavable prodrug) and a GI enzyme inhibitor (e.g., trypsininhibitor), where the single dose unit provide a therapeuticallyeffective amount of drug (i.e., a sufficient amount of drug to effect atherapeutic effect, e.g., a dose within the respective drug'stherapeutic window, or therapeutic range). “Multiple dose units” or“multiples of a dose unit” or a “multiple of a dose unit” refers to atleast two single dose units.

“Gastrointestinal enzyme” or “GI enzyme” refers to an enzyme located inthe gastrointestinal (GI) tract, which encompasses the anatomical sitesfrom mouth to anus. Trypsin is an example of a GI enzyme.

“Gastrointestinal enzyme-cleavable moiety” or “GI enzyme-cleavablemoiety” refers to a group comprising a site susceptible to cleavage by aGI enzyme. For example, a “trypsin-cleavable moiety” refers to a groupcomprising a site susceptible to cleavage by trypsin.

“Gastrointestinal enzyme inhibitor” or “GI enzyme inhibitor” refers toany agent capable of inhibiting the action of a gastrointestinal enzymeon a substrate. The term also encompasses salts of gastrointestinalenzyme inhibitors. For example, a “trypsin inhibitor” refers to anyagent capable of inhibiting the action of trypsin on a substrate.

“Patient” includes humans, and also other mammals, such as livestock,zoo animals, and companion animals, such as a cat, dog, or horse.

“Pharmaceutical composition” refers to at least one compound and canfurther comprise a pharmaceutically acceptable carrier, with which thecompound is administered to a patient.

“Pharmaceutically acceptable carrier” refers to a diluent, adjuvant,excipient or vehicle with, or in which a compound is administered.

“Pharmaceutically acceptable salt” refers to a salt of a compound, whichpossesses the desired pharmacological activity of the compound. Suchsalts include: (1) acid addition salts, formed with inorganic acids suchas hydrochloric acid, hydrobromic acid, sulfuric acid, nitric acid,phosphoric acid, and the like; or formed with organic acids such asacetic acid, propionic acid, hexanoic acid, cyclopentanepropionic acid,glycolic acid, pyruvic acid, lactic acid, malonic acid, succinic acid,malic acid, maleic acid, fumaric acid, tartaric acid, citric acid,benzoic acid, 3-(4-hydroxybenzoyl)benzoic acid, cinnamic acid, mandelicacid, methanesulfonic acid, ethanesulfonic acid, 1,2-ethane-disulfonicacid, 2-hydroxyethanesulfonic acid, benzenesulfonic acid,4-chlorobenzenesulfonic acid, 2-naphthalenesulfonic acid,4-toluenesulfonic acid, camphorsulfonic acid,4-methylbicyclo[2.2.2]-oct-2-ene-1-carboxylic acid, glucoheptonic acid,3-phenylpropionic acid, trimethylacetic acid, tertiary butylacetic acid,lauryl sulfuric acid, gluconic acid, glutamic acid, hydroxynaphthoicacid, salicylic acid, stearic acid, muconic acid, and the like; or (2)salts formed when an acidic proton present in the compound is replacedby a metal ion, e.g., an alkali metal ion, an alkaline earth ion, or analuminum ion; or coordinates with an organic base such as ethanolamine,diethanolamine, triethanolamine, N-methylglucamine and the like.

“Pharmacodynamic (PD) profile” refers to a profile of the efficacy of adrug in a patient (or subject or user), which is characterized by PDparameters. “PD parameters” include “drug Emax” (the maximum drugefficacy), “drug EC50” (the concentration of drug at 50% of the Emax)and side effects.

“PK parameter” refers to a measure of drug concentration in blood orplasma, such as: 1) “drug Cmax”, the maximum concentration of drugachieved in blood or plasma; 2) “drug Tmax”, the time elapsed followingingestion to achieve Cmax; and 3) “drug exposure”, the totalconcentration of drug present in blood or plasma over a selected periodof time, which can be measured using the area under the curve (AUC) of atime course of drug release over a selected period of time (t).Modification of one or more PK parameters provides for a modified PKprofile.

“PK profile” refers to a profile of drug concentration in blood orplasma. Such a profile can be a relationship of drug concentration overtime (i.e., a “concentration-time PK profile”) or a relationship of drugconcentration versus number of doses ingested (i.e., a“concentration-dose PK profile”). A PK profile is characterized by PKparameters.

“Preventing” or “prevention” or “prophylaxis” refers to a reduction inrisk of occurrence of a condition, such as pain.

“Prodrug” refers to a derivative of an active agent that requires atransformation within the body to release the active agent. In certainembodiments, the transformation is an enzymatic transformation. Incertain embodiments, the transformation is a cyclization transformation.In certain embodiments, the transformation is a combination of anenzymatic transformation and a cyclization transformation. Prodrugs arefrequently, although not necessarily, pharmacologically inactive untilconverted to the active agent.

“Promoiety” refers to a form of protecting group that when used to maska functional group within an active agent converts the active agent intoa prodrug. Typically, the promoiety will be attached to the drug viabond(s) that are cleaved by enzymatic or non-enzymatic means in vivo.

“Solvate” as used herein refers to a complex or aggregate formed by oneor more molecules of a solute, e.g. a prodrug or a pharmaceuticallyacceptable salt thereof, and one or more molecules of a solvent. Suchsolvates are typically crystalline solids having a substantially fixedmolar ratio of solute and solvent. Representative solvents include byway of example, water, methanol, ethanol, isopropanol, acetic acid, andthe like. When the solvent is water, the solvate formed is a hydrate.

“Therapeutically effective amount” means the amount of a compound (e.g.,prodrug) that, when administered to a patient for preventing or treatinga condition such as pain, is sufficient to effect such treatment. The“therapeutically effective amount” will vary depending on the compound,the condition and its severity and the age, weight, etc., of thepatient.

“Treating” or “treatment” of any condition, such as pain, refers, incertain embodiments, to ameliorating the condition (i.e., arresting orreducing the development of the condition). In certain embodiments“treating” or “treatment” refers to ameliorating at least one physicalparameter, which may not be discernible by the patient. In certainembodiments, “treating” or “treatment” refers to inhibiting thecondition, either physically, (e.g., stabilization of a discerniblesymptom), physiologically, (e.g., stabilization of a physicalparameter), or both. In certain embodiments, “treating” or “treatment”refers to delaying the onset of the condition.

DETAILED DESCRIPTION

Before the present invention is further described, it is to beunderstood that this invention is not limited to particular embodimentsdescribed, as such may, of course, vary. It is also to be understoodthat the terminology used herein is for the purpose of describingparticular embodiments only, and is not intended to be limiting, sincethe scope of the present invention will be limited only by the appendedclaims.

It must be noted that as used herein and in the appended claims, thesingular forms “a,” “an,” and “the” include plural referents unless thecontext clearly dictates otherwise. It is further noted that the claimsmay be drafted to exclude any optional element. As such, this statementis intended to serve as antecedent basis for use of such exclusiveterminology as “solely,” “only” and the like in connection with therecitation of claim elements, or use of a “negative” limitation.

It should be understood that as used herein, the term “a” entity or “an”entity refers to one or more of that entity. For example, a compoundrefers to one or more compounds. As such, the terms “a”, “an”, “one ormore” and “at least one” can be used interchangeably. Similarly theterms “comprising”, “including” and “having” can be usedinterchangeably.

The publications discussed herein are provided solely for theirdisclosure prior to the filing date of the present application. Nothingherein is to be construed as an admission that the present invention isnot entitled to antedate such publication by virtue of prior invention.Further, the dates of publication provided may be different from theactual publication dates which may need to be independently confirmed.

Unless defined otherwise, all technical and scientific terms used hereinhave the same meaning as commonly understood by one of ordinary skill inthe art to which this invention belongs. Although any methods andmaterials similar or equivalent to those described herein can also beused in the practice or testing of the present invention, the preferredmethods and materials are now described. All publications mentionedherein are incorporated herein by reference to disclose and describe themethods and/or materials in connection with which the publications arecited.

Except as otherwise noted, the methods and techniques of the presentembodiments are generally performed according to conventional methodswell known in the art and as described in various general and morespecific references that are cited and discussed throughout the presentspecification. See, e.g., Loudon, Organic Chemistry, Fourth Edition, NewYork: Oxford University Press, 2002, pp. 360-361, 1084-1085; Smith andMarch, March's Advanced Organic Chemistry: Reactions, Mechanisms, andStructure, Fifth Edition, Wiley-Interscience, 2001.

The nomenclature used herein to name the subject compounds isillustrated in the Examples herein. In certain instances, thisnomenclature has is derived using the commercially-available AutoNomsoftware (MDL, San Leandro, Calif.).

It is appreciated that certain features of the invention, which are, forclarity, described in the context of separate embodiments, may also beprovided in combination in a single embodiment. Conversely, variousfeatures of the invention, which are, for brevity, described in thecontext of a single embodiment, may also be provided separately or inany suitable sub-combination. All combinations of the embodimentspertaining to the chemical groups represented by the variables arespecifically embraced by the present invention and are disclosed hereinjust as if each and every combination was individually and explicitlydisclosed, to the extent that such combinations embrace compounds thatare stable compounds (i.e., compounds that can be isolated,characterised, and tested for biological activity). In addition, allsub-combinations of the chemical groups listed in the embodimentsdescribing such variables are also specifically embraced by the presentinvention and are disclosed herein just as if each and every suchsub-combination of chemical groups was individually and explicitlydisclosed herein.

General Synthetic Procedures

Many general references providing commonly known chemical syntheticschemes and conditions useful for synthesizing the disclosed compoundsare available (see, e.g., Smith and March, March's Advanced OrganicChemistry: Reactions, Mechanisms, and Structure, Fifth Edition,Wiley-Interscience, 2001; or Vogel, A Textbook of Practical OrganicChemistry, Including Qualitative Organic Analysis, Fourth Edition, NewYork: Longman, 1978).

Compounds as described herein can be purified by any of the means knownin the art, including chromatographic means, such as high performanceliquid chromatography (HPLC), preparative thin layer chromatography,flash column chromatography and ion exchange chromatography. Anysuitable stationary phase can be used, including normal and reversedphases as well as ionic resins. See, e.g., Introduction to Modern LiquidChromatography, 2nd Edition, ed. L. R. Snyder and J. J. Kirkland, JohnWiley and Sons, 1979; and Thin Layer Chromatography, ed. E. Stahl,Springer-Verlag, New York, 1969.

During any of the processes for preparation of the compounds of thepresent disclosure, it may be necessary and/or desirable to protectsensitive or reactive groups on any of the molecules concerned. This canbe achieved by means of conventional protecting groups as described instandard works, such as T. W. Greene and P. G. M. Wuts, “ProtectiveGroups in Organic Synthesis”, Fourth edition, Wiley, New York 2006. Theprotecting groups can be removed at a convenient subsequent stage usingmethods known from the art.

The compounds described herein can contain one or more chiral centersand/or double bonds and therefore, can exist as stereoisomers, such asdouble-bond isomers (i.e., geometric isomers), enantiomers ordiastereomers. Accordingly, all possible enantiomers and stereoisomersof the compounds including the stereoisomerically pure form (e.g.,geometrically pure, enantiomerically pure or diastereomerically pure)and enantiomeric and stereoisomeric mixtures are included in thedescription of the compounds herein. Enantiomeric and stereoisomericmixtures can be resolved into their component enantiomers orstereoisomers using separation techniques or chiral synthesis techniqueswell known to the skilled artisan. The compounds can also exist inseveral tautomeric forms including the enol form, the keto form andmixtures thereof. Accordingly, the chemical structures depicted hereinencompass all possible tautomeric forms of the illustrated compounds.

The compounds described also include isotopically labeled compoundswhere one or more atoms have an atomic mass different from the atomicmass conventionally found in nature. Examples of isotopes that can beincorporated into the compounds disclosed herein include, but are notlimited to, ²H, ³H, ¹¹C, ¹³C, ¹⁴C, ¹⁵N, ¹⁸O, ¹⁷O, etc. Compounds canexist in unsolvated forms as well as solvated forms, including hydratedforms. In general, compounds can be hydrated or solvated. Certaincompounds can exist in multiple crystalline or amorphous forms. Ingeneral, all physical forms are equivalent for the uses contemplatedherein and are intended to be within the scope of the presentdisclosure.

Representative Embodiments

Reference will now be made in detail to various embodiments. It will beunderstood that the invention is not limited to these embodiments. Tothe contrary, it is intended to cover alternatives, modifications, andequivalents as may be included within the spirit and scope of theallowed claims.

The disclosure provides a method of providing a patient with postadministration-activated, controlled release of an opioid, whichcomprises administering to the patient a corresponding compound in whichthe opioid has a substituent which is a spacer leaving group bearing anucleophilic nitrogen that is protected with an enzyme-cleavable moiety,the configuration of the spacer leaving group being such that, uponenzymatic cleavage of the cleavable moiety, the nucleophilic nitrogen iscapable of forming a cyclic urea, liberating the compound from thespacer leaving group so as to provide the patient with controlledrelease of an opioid.

The corresponding compound (prodrug in accordance with the presentdisclosure) provides post administration-activated, controlled releaseof an opioid, because it requires enzymatic cleavage to initiate releaseof the compound, and because the rate of release of the opioid dependsupon both the rate of enzymatic cleavage and the rate of cyclization.The prodrug is configured so that it will not provide excessively highplasma levels of the opioid if it is administered inappropriately, andcannot readily be decomposed to afford the opioid other than byenzymatic cleavage followed by controlled cyclization.

The enzyme capable of cleaving the enzyme-cleavable moiety can be apeptidase, also referred to as a protease—the enzyme-cleavable moietybeing linked to the nucleophilic nitrogen through an amide (e.g. apeptide: —NHCO—) bond. In some embodiments, the enzyme is a digestiveenzyme, such as a digestive enzyme of a protein.

The enzyme-cleavable moiety linked to the nucleophilic nitrogen throughan amide bond can be, for example, a residue of an amino acid or apeptide, a variant of a residue of an amino acid or a peptide, aderivative of a residue of an amino acid or a peptide, or a derivativeof a residue of an amino acid variant or a peptide variant. As discussedbelow, an amino acid variant refers to an amino acid other than any ofthe 20 common naturally occurring L-amino acids that is hydrolyzable bya protease in a manner similar to the ability of a protease to hydrolyzea naturally occurring L-amino acid. A derivative refers to a substancethat has been altered from another substance by modification, partialsubstitution, homologation, truncation, or a change in oxidation state.For example, an N-acyl derivative of an amino acid is an example of aderivative of an amino acid.

In some instances, the enzyme-cleavable moiety can be an (alpha) N-acylderivative of an amino acid or peptide or an (alpha) N-acyl derivativeof an amino acid variant or peptide variant.

The peptide can contain, for example, up to about 100 amino acidresidues. Each amino acid can advantageously be a naturally occurringamino acid, such as an L-amino acid. Examples of naturally occurringamino acids are alanine, arginine, asparagine, aspartic acid, cysteine,glutamic acid, glutamine, glycine, histidine, isoleucine, leucine,lysine, methionine, phenylalanine, proline, serine, threonine,tryptophan, tyrosine and valine. Accordingly, examples ofenzyme-cleavable moieties include residues of the L-amino acids listedherein and N-acyl derivatives thereof, and peptides formed from at leasttwo of the L-amino acids listed herein and the N-acyl derivativesthereof. Additional examples include residues of amino acid variants andN-acyl derivatives thereof, and peptides formed from at least two of theL-amino acids listed above and/or variants thereof, and N-acylderivatives thereof. Also included are derivatives of such amino acidsor amino acid variants and peptides thereof.

The embodiments provide a prodrug with a substituent which is a spacerleaving group bearing a nucleophilic nitrogen that is protected with anenzyme-cleavable moiety. Upon enzymatic cleavage of the cleavablemoiety, the nucleophilic nitrogen is capable of forming a cyclic urea. Arepresentative scheme of a cyclization of a spacer group is shown below,wherein X is an opioid.

The rate of cyclization of the cyclic urea can be adjusted byincorporation of a heterocyclic ring within the spacer group. In certainembodiments, incorporation of a heterocyclic ring within the spacergroup results in formation of a fused ring cyclic urea and in a fastercyclization reaction.

The cyclic group formed when the opioid is released is convenientlypharmaceutically acceptable, in particular a pharmaceutically acceptablecyclic urea. It will be appreciated that cyclic ureas are generally verystable and have low toxicity.

According to one aspect, the embodiments include pharmaceuticalcompositions, which comprise a GI enzyme-cleavable opioid prodrug and anoptional GI enzyme inhibitor. Examples of opioid prodrugs and enzymeinhibitors are described below.

Opioid Prodrugs

An “opioid” refers to a chemical substance that exerts itspharmacological action by interaction at an opioid receptor. An opioidcan be a natural product, a synthetic compound or a semi-syntheticcompound. In certain embodiments, an opioid is a compound with apharmacophore that presents to the opioid receptor an aromatic group andan aliphatic amine group in an architecturally discrete way. See, forexample, Foye's Principles of Medicinal Chemistry, Sixth Edition, ed. T.L. Lemke and D. A. Williams, Lippincott Williams & Wilkins, 2008,particularly Chapter 24, pages 653-678.

The disclosure provides an opioid prodrug that provides controlledrelease of an opioid. The disclosure provides a promoiety that isattached to an opioid through any structural moiety on the opioid, wherethe structural moiety has a reactive group. Examples of reactive groupson an opioid include, but are not limited to ketone, phenol, and amide.

It is contemplated that opioids bearing at least some of thefunctionalities described herein will be developed; such opioids areincluded as part of the scope of this disclosure.

Formula I

Compounds of the present disclosure include compounds of formula I shownbelow. Compositions of the present disclosure also include compounds offormula I shown below. Pharmaceutical compositions and methods of thepresent disclosure also contemplate compounds of formula I.

The present embodiments provide a compound of formula I:

wherein

X is selected from a residue of a ketone-containing opioid, wherein thehydrogen atom of the corresponding hydroxyl group of the enolic tautomerof the ketone is replaced by a covalent bond to —C(O)—N[(Aring)-Y_(c)]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R⁵)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷;a residue of a phenolic opioid, wherein the hydrogen atom of thephenolic hydroxyl group is replaced by a covalent bond to —C(O)—N[(Aring)-Y_(c)]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷;and a residue of an amide-containing opioid, wherein —C(O)—N[(Aring)-Y_(c)]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷is connected to the amide-containing opioid through the oxygen of theamide group, wherein the amide group is converted to an amide enol or animine tautomer;

the A ring is a heterocyclic 5 to 12-membered ring;

each Y is independently selected from alkyl, substituted alkyl, alkenyl,substituted alkenyl, alkynyl, substituted alkynyl, aryl, substitutedaryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl, substitutedalkoxycarbonyl, aminoacyl, substituted aminoacyl, amino, substitutedamino, acylamino, substituted acylamino, and cyano;

c is a number from zero to 3;

each R¹ is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano;

each R² is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano; or

R¹ and R² together with the carbon to which they are attached can form acycloalkyl or substituted cycloalkyl group, or two R¹ or R² groups onadjacent carbon atoms, together with the carbon atoms to which they areattached, can form a cycloalkyl or substituted cycloalkyl group;

a is an integer from one to 8;

provided that when a is one, the A ring is a heterocyclic 6 to12-membered ring; and when the A ring is a heterocyclic 5-membered ring,then a is an integer from 2 to 8;

each R³ is independently hydrogen, alkyl, substituted alkyl, aryl orsubstituted aryl;

R⁵ is selected from hydrogen, alkyl, substituted alkyl, aryl,substituted aryl, arylalkyl, substituted arylalkyl, heteroalkyl,substituted heteroalkyl, heteroaryl, substituted heteroaryl,heteroarylalkyl, and substituted heteroarylalkyl;

each R⁶ is independently selected from hydrogen, alkyl, substitutedalkyl, aryl, substituted aryl, arylalkyl, substituted arylalkyl,heteroalkyl, substituted heteroalkyl, heteroaryl, substitutedheteroaryl, heteroarylalkyl, and substituted heteroarylalkyl;

b is a number from zero to 100; and

R⁷ is selected from hydrogen, alkyl, substituted alkyl, acyl,substituted acyl, alkoxycarbonyl, substituted alkoxycarbonyl, aryl,substituted aryl, arylalkyl, and substituted arylalkyl;

or a salt, hydrate or solvate thereof.

In formula I, X can be selected from a residue of a ketone-containingopioid, wherein the hydrogen atom of the corresponding hydroxyl group ofthe enolic tautomer of the ketone is replaced by a covalent bond to—C(O)—N[(Aring)-Y_(c)]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷;a residue of a phenolic opioid, wherein the hydrogen atom of thephenolic hydroxyl group is replaced by a covalent bond to —C(O)—N[(Aring)-Y_(c)]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷;and a residue of an amide-containing opioid, wherein —C(O)—N[(Aring)-Y_(c)]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷is connected to the amide-containing opioid through the oxygen of theamide group, wherein the amide group is converted to an amide enol or animine tautomer.

In certain instances, X is a ketone-containing opioid, wherein thehydrogen atom of the corresponding hydroxyl group of the enolic tautomerof the ketone is replaced by a covalent bond to —C(O)—N[(Aring)-Y_(c)]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷.

In certain instances, X is a ketone-containing opioid, wherein theopioid is selected from acetylmorphone, hydrocodone, hydromorphone,ketobemidone, methadone, naloxone, naltrexone, N-methylnaloxone,N-methylnaltrexone, oxycodone, oxymorphone, and pentamorphone.

In certain instances, X is a residue of a phenolic opioid, wherein thehydrogen atom of the phenolic hydroxyl group is replaced by a covalentbond to —C(O)—N[(Aring)-Y_(c)]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷.

In certain instances, X is a phenolic opioid, wherein the opioid isselected from buprenorphine, dihydroetorphine, diprenorphine, etorphine,hydromorphone, levorphanol, morphine, nalbuphine, nalmefene, nalorphine,naloxone, naltrexone, N-methyldiprenorphine, N-methylnaloxone,N-methylnaltrexone, oripavine, oxymorphone, butorphanol, dezocine,ketobemidone, meptazinol, o-desmethyltramadol, pentazocine, phenazocine,and tapentadol.

In certain instances, X is a residue of an amide-containing opioid,wherein —C(O)—N[(Aring)-Y_(c)]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷is connected to the amide-containing opioid through the oxygen of theamide group, wherein the amide group is converted to an amide enol or animine tautomer.

In certain instances, X is an amide-containing opioid, wherein theopioid is selected from alfentanil, carfentanil, fentanyl, lofentanil,loperamide, olmefentanyl, remifentanil, and sufentanil.

Ketone-Modified Opioid Prodrugs

The disclosure provides a ketone-modified opioid prodrug that providescontrolled release of a ketone-containing opioid. In a ketone-modifiedopioid prodrug, a promoiety is attached to the ketone-containing opioidthrough the enolic oxygen atom of the ketone moiety. In aketone-modified opioid prodrug, the hydrogen atom of the correspondinghydroxyl group of the enolic tautomer of the ketone-containing opioid isreplaced by a covalent bond to a promoiety.

As disclosed herein, an enzyme-cleavable ketone-modified opioid prodrugis a ketone-modified opioid prodrug that comprises a promoietycomprising an enzyme-cleavable moiety, i.e., a moiety having a sitesusceptible to cleavage by an enzyme. In one embodiment, the cleavablemoiety is a GI enzyme-cleavable moiety, such as a trypsin-cleavablemoiety. Such a prodrug comprises a ketone-containing opioid covalentlybound to a promoiety comprising an enzyme-cleavable moiety, whereincleavage of the enzyme-cleavable moiety by an enzyme mediates release ofthe drug.

Formulae II-V

Compounds of the present disclosure include compounds of formulae II-Vshown below. Compositions of the present disclosure also includecompounds of formulae II-V shown below. Pharmaceutical compositions andmethods of the present disclosure also contemplate compounds of formulaeII-V.

The present embodiments provide a compound of formula II:

wherein

X represents a residue of a ketone-containing opioid, wherein thehydrogen atom of the corresponding hydroxyl group of the enolic tautomerof the ketone is replaced by a covalent bond to —C(O)—N[(Aring)-Y_(c)]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷;

the A ring is a heterocyclic 5 to 12-membered ring;

each Y is independently selected from alkyl, substituted alkyl, alkenyl,substituted alkenyl, alkynyl, substituted alkynyl, aryl, substitutedaryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl, substitutedalkoxycarbonyl, aminoacyl, substituted aminoacyl, amino, substitutedamino, acylamino, substituted acylamino, and cyano;

c is a number from zero to 3;

each R¹ is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano;

each R² is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano; or

R¹ and R² together with the carbon to which they are attached can form acycloalkyl or substituted cycloalkyl group, or two R¹ or R² groups onadjacent carbon atoms, together with the carbon atoms to which they areattached, can form a cycloalkyl or substituted cycloalkyl group;

a is an integer from one to 8;

provided that when a is one, the A ring is a heterocyclic 6 to12-membered ring; and when the A ring is a heterocyclic 5-membered ring,then a is an integer from 2 to 8;

each R³ is independently hydrogen, alkyl, substituted alkyl, aryl orsubstituted aryl;

R⁵ is selected from hydrogen, alkyl, substituted alkyl, aryl,substituted aryl, arylalkyl, substituted arylalkyl, heteroalkyl,substituted heteroalkyl, heteroaryl, substituted heteroaryl,heteroarylalkyl, and substituted heteroarylalkyl;

each R⁶ is independently selected from hydrogen, alkyl, substitutedalkyl, aryl, substituted aryl, arylalkyl, substituted arylalkyl,heteroalkyl, substituted heteroalkyl, heteroaryl, substitutedheteroaryl, heteroarylalkyl, and substituted heteroarylalkyl;

b is a number from zero to 100; and

R⁷ is selected from hydrogen, alkyl, substituted alkyl, acyl,substituted acyl, alkoxycarbonyl, substituted alkoxycarbonyl, aryl,substituted aryl, arylalkyl, and substituted arylalkyl;

or a salt, hydrate or solvate thereof.

The present embodiments provide a compound of formula III:

wherein

R^(a) is hydrogen or hydroxyl;

R^(b) is hydrogen or alkyl;

the A ring is a heterocyclic 5 to 12-membered ring;

each Y is independently selected from alkyl, substituted alkyl, alkenyl,substituted alkenyl, alkynyl, substituted alkynyl, aryl, substitutedaryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl, substitutedalkoxycarbonyl, aminoacyl, substituted aminoacyl, amino, substitutedamino, acylamino, substituted acylamino, and cyano;

c is a number from zero to 3;

each R¹ is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano;

each R² is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano; or

R¹ and R² together with the carbon to which they are attached can form acycloalkyl or substituted cycloalkyl group, or two R¹ or R² groups onadjacent carbon atoms, together with the carbon atoms to which they areattached, can form a cycloalkyl or substituted cycloalkyl group;

a is an integer from one to 8;

provided that when a is one, the A ring is a heterocyclic 6 to12-membered ring; and when the A ring is a heterocyclic 5-membered ring,then a is an integer from 2 to 8;

each R³ is independently hydrogen, alkyl, substituted alkyl, aryl orsubstituted aryl;

R⁵ is selected from hydrogen, alkyl, substituted alkyl, aryl,substituted aryl, arylalkyl, substituted arylalkyl, heteroalkyl,substituted heteroalkyl, heteroaryl, substituted heteroaryl,heteroarylalkyl, and substituted heteroarylalkyl;

each R⁶ is independently selected from hydrogen, alkyl, substitutedalkyl, aryl, substituted aryl, arylalkyl, substituted arylalkyl,heteroalkyl, substituted heteroalkyl, heteroaryl, substitutedheteroaryl, heteroarylalkyl, and substituted heteroarylalkyl;

b is a number from zero to 100; and

R⁷ is selected from hydrogen, alkyl, substituted alkyl, acyl,substituted acyl, alkoxycarbonyl, substituted alkoxycarbonyl, aryl,substituted aryl, arylalkyl, and substituted arylalkyl;

or a salt, hydrate or solvate thereof.

The present embodiments provide a compound of formula IV:

wherein

X represents a residue of a ketone-containing opioid, wherein thehydrogen atom of the corresponding hydroxyl group of the enolic tautomerof the ketone is replaced by a covalent bond to —C(O)—N[(Aring)-Y_(c)]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷;

the A ring is a heterocyclic 5 to 12-membered ring;

each Y is independently selected from alkyl, substituted alkyl, alkenyl,substituted alkenyl, alkynyl, substituted alkynyl, aryl, substitutedaryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl, substitutedalkoxycarbonyl, aminoacyl, substituted aminoacyl, amino, substitutedamino, acylamino, substituted acylamino, and cyano;

c is a number from zero to 3;

each R¹ is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano;

each R² is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano; or

R¹ and R² together with the carbon to which they are attached can form acycloalkyl or substituted cycloalkyl group, or two R¹ or R² groups onadjacent carbon atoms, together with the carbon atoms to which they areattached, can form a cycloalkyl or substituted cycloalkyl group;

a is an integer from one to 8;

provided that when a is one, the A ring is a heterocyclic 6 to12-membered ring; and when the A ring is a heterocyclic 5-membered ring,then a is an integer from 2 to 8;

each R³ is independently hydrogen, alkyl, substituted alkyl, aryl orsubstituted aryl;

R⁵ is a side chain of an amino acid selected from alanine, arginine,asparagine, aspartic acid, cysteine, glutamic acid, glutamine, glycine,histidine, isoleucine, leucine, lysine, methionine, phenylalanine,proline, serine, threonine, tryptophan, tyrosine, valine, homoarginine,homolysine, ornithine, arginine mimic, arginine homologue, argininetruncate, arginine with varying oxidation states, lysine mimic, lysinehomologue, lysine truncate, and lysine with varying oxidation states;

each R⁶ is a side chain of an amino acid independently selected fromalanine, arginine, asparagine, aspartic acid, cysteine, glutamic acid,glutamine, glycine, histidine, isoleucine, leucine, lysine, methionine,phenylalanine, proline, serine, threonine, tryptophan, tyrosine andvaline;

b is a number from zero to 100;

R⁷ is selected from hydrogen, alkyl, substituted alkyl, acyl,substituted acyl, alkoxycarbonyl, substituted alkoxycarbonyl, aryl,substituted aryl, arylalkyl, and substituted arylalkyl;

or a salt, hydrate or solvate thereof.

The present embodiments provide a compound of formula V:

wherein

X represents a residue of a ketone-containing opioid, wherein thehydrogen atom of the corresponding hydroxyl group of the enolic tautomerof the ketone is replaced by a covalent bond to —C(O)—N[(Aring)-Y_(c)]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷;

the A ring is a heterocyclic 5 to 12-membered ring;

each Y is independently selected from alkyl, substituted alkyl, alkenyl,substituted alkenyl, alkynyl, substituted alkynyl, aryl, substitutedaryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl, substitutedalkoxycarbonyl, aminoacyl, substituted aminoacyl, amino, substitutedamino, acylamino, substituted acylamino, and cyano;

c is a number from zero to 3;

each R¹ is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano;

each R² is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano; or

R¹ and R² together with the carbon to which they are attached can form acycloalkyl or substituted cycloalkyl group, or two R¹ or R² groups onadjacent carbon atoms, together with the carbon atoms to which they areattached, can form a cycloalkyl or substituted cycloalkyl group;

a is an integer from one to 8;

provided that when a is one, the A ring is a heterocyclic 6 to12-membered ring; and when the A ring is a heterocyclic 5-membered ring,then a is an integer from 2 to 8;

each R³ is independently hydrogen, alkyl, substituted alkyl, aryl orsubstituted aryl;

R⁵ represents a side chain of an amino acid, a side chain of an aminoacid variant, a derivative of a side chain of an amino acid, or aderivative of a side chain of an amino acid variant that effects—C(O)—CH(R⁵)—N(R³)— to be a GI enzyme-cleavable moiety;

each R⁶ represents a side chain of an amino acid independently selectedfrom alanine, arginine, asparagine, aspartic acid, cysteine, glutamicacid, glutamine, glycine, histidine, isoleucine, leucine, lysine,methionine, phenylalanine, proline, serine, threonine, tryptophan,tyrosine and valine;

b is a number from zero to 100;

R⁷ is selected from hydrogen, alkyl, substituted alkyl, acyl,substituted acyl, alkoxycarbonyl, substituted alkoxycarbonyl, aryl,substituted aryl, arylalkyl, and substituted arylalkyl;

or a salt, hydrate or solvate thereof.

In formula II and IV-V, X can be a residue of a ketone-containingopioid.

A “ketone-containing opioid” refers to a subset of the opioids thatcontain a ketone group. As used herein, a ketone-containing opioid is anopioid containing an enolizable ketone group. A ketone-containing opioidis a compound with a pharmacophore that presents to the opioid receptoran aromatic group and an aliphatic amine group in an architecturallydiscrete way. See, for example, Foye's Principles of MedicinalChemistry, Sixth Edition, ed. T. L. Lemke and D. A. Williams, LippincottWilliams & Wilkins, 2008, particularly Chapter 24, pages 653-678.

For example, ketone-containing opioids include, but are not limited to,acetylmorphone, hydrocodone, hydromorphone, ketobemidone, methadone,naloxone, naltrexone, N-methylnaloxone, N-methylnaltrexone, oxycodone,oxymorphone, and pentamorphone.

In certain embodiments, the ketone-containing opioid is hydrocodone,hydromorphone, oxycodone, or oxymorphone.

In certain embodiments, the ketone-containing opioid is naloxone,naltrexone, N-methylnaloxone, or N-methylnaltrexone.

In certain embodiments, the ketone-containing opioid is hydrocodone oroxycodone. In certain embodiments, the ketone-containing opioid ishydrocodone. In certain embodiments, the ketone-containing opioid isoxycodone.

It is contemplated that opioids bearing at least some of thefunctionalities described herein will be developed; such opioids areincluded as part of the scope of this disclosure.

In formula III, R^(a) can be hydrogen or hydroxyl. In certain instances,R^(a) is hydrogen. In other instances, R^(a) is hydroxyl.

In formula III, R^(b) is hydrogen or alkyl. In certain instances, R^(b)is hydrogen. In other instances, R^(b) is alkyl.

Particular compounds of interest, and salts or solvates or stereoisomersthereof, include:

-   N-(oxycodone-6-enol-carbonyl)-R-(piperidine-2-methylamine)-L-arginine-glycine-malonate    (Compound KC-17):

-   N-(oxycodone-6-enol-carbonyl)piperidine-2-methylamine-L-arginine-malonate    (Compound KC-12):

-   N-(oxycodone-6-enol-carbonyl)piperidine-2-methylamine-L-arginine-L-alanine-acetate    (Compound KC-13):

-   N-(oxycodone-6-enol-carbonyl)piperidine-2-methylamine-L-arginine-glycine-acetate    (Compound KC-14):

-   N-(oxycodone-6-enol-carbonyl)piperidine-2-methylamine-L-arginine-L-alanine-malonate    (Compound KC-15):

-   N-(oxycodone-6-enol-carbonyl)piperidine-2-methylamine-L-arginine-glycine-malonate    (Compound KC-16):

and

-   N-(hydrocodone-6-enol-carbonyl)-R-(piperidine-2-methylamine)-L-arginine-glycine-malonate    (Compound KC-31):

Particular compounds of interest, and salts or solvates or stereoisomersthereof, include:

Compound KC-32:

Compound KC-35:

Compound KC-36:

Compound KC-37:

Compound KC-38:

Compound KC-39:

Compound KC-40:

Compound KC-41:

Compound KC-42:

Compound KC-43:

Compound KC-44:

Compound KC-45:

Compound KC-46:

Compound KC-47:

Compound KC-48:

Compound KC-49:

Compound KC-50:

Compound KC-51:

Compound KC-52:

Compound KC-53:

and

Compound KC-55:

Phenolic Opioid Prodrugs

The disclosure provides a phenolic opioid prodrug that providescontrolled release of a phenolic opioid. In a phenolic opioid prodrug, apromoiety is attached to the phenolic opioid through the phenolic oxygenatom. In a phenolic opioid prodrug, the oxygen atom of the phenol groupof the phenolic opioid is replaced by a covalent bond to a promoiety.

As disclosed herein, an enzyme-cleavable phenolic opioid prodrug is aphenolic opioid prodrug that comprises a promoiety comprising anenzyme-cleavable moiety, i.e., a moiety having a site susceptible tocleavage by an enzyme. In one embodiment, the cleavable moiety is a GIenzyme-cleavable moiety, such as a trypsin-cleavable moiety. Such aprodrug comprises a phenolic opioid covalently bound to a promoietycomprising an enzyme-cleavable moiety, wherein cleavage of theenzyme-cleavable moiety by an enzyme mediates release of the drug.

Formulae VI-IX

Compounds of the present disclosure include compounds of formulae VI-IXshown below. Compositions of the present disclosure also includecompounds of formulae VI-IX shown below. Pharmaceutical compositions andmethods of the present disclosure also contemplate compounds of formulaeVI-IX.

The present embodiments provide a compound of formula VI:

wherein

X represents a residue of a phenolic opioid, wherein the hydrogen atomof the phenolic hydroxyl group is replaced by a covalent bond to—C(O)—N[(Aring)-Y_(c)]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷;

the A ring is a heterocyclic 5 to 12-membered ring;

each Y is independently selected from alkyl, substituted alkyl, alkenyl,substituted alkenyl, alkynyl, substituted alkynyl, aryl, substitutedaryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl, substitutedalkoxycarbonyl, aminoacyl, substituted aminoacyl, amino, substitutedamino, acylamino, substituted acylamino, and cyano;

c is a number from zero to 3;

each R¹ is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano;

each R² is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano; or

R¹ and R² together with the carbon to which they are attached can form acycloalkyl or substituted cycloalkyl group, or two R¹ or R² groups onadjacent carbon atoms, together with the carbon atoms to which they areattached, can form a cycloalkyl or substituted cycloalkyl group;

a is an integer from one to 8;

provided that when a is one, the A ring is a heterocyclic 6 to12-membered ring; and when the A ring is a heterocyclic 5-membered ring,then a is an integer from 2 to 8;

each R³ is independently hydrogen, alkyl, substituted alkyl, aryl orsubstituted aryl;

R⁵ is selected from hydrogen, alkyl, substituted alkyl, aryl,substituted aryl, arylalkyl, substituted arylalkyl, heteroalkyl,substituted heteroalkyl, heteroaryl, substituted heteroaryl,heteroarylalkyl, and substituted heteroarylalkyl;

each R⁶ is independently selected from hydrogen, alkyl, substitutedalkyl, aryl, substituted aryl, arylalkyl, substituted arylalkyl,heteroalkyl, substituted heteroalkyl, heteroaryl, substitutedheteroaryl, heteroarylalkyl, and substituted heteroarylalkyl;

b is a number from zero to 100;

R⁷ is selected from hydrogen, alkyl, substituted alkyl, acyl,substituted acyl, alkoxycarbonyl, substituted alkoxycarbonyl, aryl,substituted aryl, arylalkyl, and substituted arylalkyl;

or a salt, hydrate or solvate thereof.

The present embodiments provide a compound of formula VII:

wherein

R^(a) is hydrogen or hydroxyl;

R^(b) is hydrogen or alkyl;

the A ring is a heterocyclic 5 to 12-membered ring;

each Y is independently selected from alkyl, substituted alkyl, alkenyl,substituted alkenyl, alkynyl, substituted alkynyl, aryl, substitutedaryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl, substitutedalkoxycarbonyl, acylamino, substituted acylamino, substituted aminoacyl,amino, substituted amino, acylamino, and cyano;

c is a number from zero to 3;

each R¹ is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano;

each R² is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano; or

R¹ and R² together with the carbon to which they are attached can form acycloalkyl or substituted cycloalkyl group, or two R¹ or R² groups onadjacent carbon atoms, together with the carbon atoms to which they areattached, can form a cycloalkyl or substituted cycloalkyl group;

a is an integer from one to 8;

provided that when a is one, the A ring is a heterocyclic 6 to12-membered ring; and when the A ring is a heterocyclic 5-membered ring,then a is an integer from 2 to 8;

each R³ is independently hydrogen, alkyl, substituted alkyl, aryl orsubstituted aryl;

R⁵ is selected from hydrogen, alkyl, substituted alkyl, aryl,substituted aryl, arylalkyl, substituted arylalkyl, heteroalkyl,substituted heteroalkyl, heteroaryl, substituted heteroaryl,heteroarylalkyl, and substituted heteroarylalkyl;

each R⁶ is independently selected from hydrogen, alkyl, substitutedalkyl, aryl, substituted aryl, arylalkyl, substituted arylalkyl,heteroalkyl, substituted heteroalkyl, heteroaryl, substitutedheteroaryl, heteroarylalkyl, and substituted heteroarylalkyl;

b is a number from zero to 100;

R⁷ is selected from hydrogen, alkyl, substituted alkyl, acyl,substituted acyl, alkoxycarbonyl, substituted alkoxycarbonyl, aryl,substituted aryl, arylalkyl, and substituted arylalkyl;

or a salt, hydrate or solvate thereof.

The present embodiments provide a compound of formula VIII:

wherein

X represents a residue of a phenolic opioid, wherein the hydrogen atomof the phenolic hydroxyl group is replaced by a covalent bond to—C(O)—N[(Aring)-Y_(c)]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷;

the A ring is a heterocyclic 5 to 12-membered ring;

each Y is independently selected from alkyl, substituted alkyl, alkenyl,substituted alkenyl, alkynyl, substituted alkynyl, aryl, substitutedaryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl, substitutedalkoxycarbonyl, aminoacyl, substituted aminoacyl, amino, substitutedamino, acylamino, substituted acylamino, and cyano;

c is a number from zero to 3;

each R¹ is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano;

each R² is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano; or

R¹ and R² together with the carbon to which they are attached can form acycloalkyl or substituted cycloalkyl group, or two R¹ or R² groups onadjacent carbon atoms, together with the carbon atoms to which they areattached, can form a cycloalkyl or substituted cycloalkyl group;

a is an integer from one to 8;

provided that when a is one, the A ring is a heterocyclic 6 to12-membered ring; and when the A ring is a heterocyclic 5-membered ring,then a is an integer from 2 to 8;

each R³ is independently hydrogen, alkyl, substituted alkyl, aryl orsubstituted aryl;

R⁵ is a side chain of an amino acid selected from alanine, arginine,asparagine, aspartic acid, cysteine, glutamic acid, glutamine, glycine,histidine, isoleucine, leucine, lysine, methionine, phenylalanine,proline, serine, threonine, tryptophan, tyrosine, valine, homoarginine,homolysine, ornithine, arginine mimic, arginine homologue, argininetruncate, arginine with varying oxidation states, lysine mimic, lysinehomologue, lysine truncate, and lysine with varying oxidation states;

each R⁶ is a side chain of an amino acid independently selected fromalanine, arginine, asparagine, aspartic acid, cysteine, glutamic acid,glutamine, glycine, histidine, isoleucine, leucine, lysine, methionine,phenylalanine, proline, serine, threonine, tryptophan, tyrosine andvaline;

b is a number from zero to 100;

R⁷ is selected from hydrogen, alkyl, substituted alkyl, acyl,substituted acyl, alkoxycarbonyl, substituted alkoxycarbonyl, aryl,substituted aryl, arylalkyl, and substituted arylalkyl;

or a salt, hydrate or solvate thereof.

The present embodiments provide a compound of formula IX:

wherein

X represents a residue of a phenolic opioid, wherein the hydrogen atomof the phenolic hydroxyl group is replaced by a covalent bond to—C(O)—N[(Aring)-Y_(c)]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷;

the A ring is a heterocyclic 5 to 12-membered ring;

each Y is independently selected from alkyl, substituted alkyl, alkenyl,substituted alkenyl, alkynyl, substituted alkynyl, aryl, substitutedaryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl, substitutedalkoxycarbonyl, aminoacyl, substituted aminoacyl, amino, substitutedamino, acylamino, substituted acylamino, and cyano;

c is a number from zero to 3;

each R¹ is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano;

each R² is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano; or

R¹ and R² together with the carbon to which they are attached can form acycloalkyl or substituted cycloalkyl group, or two R¹ or R² groups onadjacent carbon atoms, together with the carbon atoms to which they areattached, can form a cycloalkyl or substituted cycloalkyl group;

a is an integer from one to 8;

provided that when a is one, the A ring is a heterocyclic 6 to12-membered ring; and when the A ring is a heterocyclic 5-membered ring,then a is an integer from 2 to 8;

each R³ is independently hydrogen, alkyl, substituted alkyl, aryl orsubstituted aryl;

R⁵ represents a side chain of an amino acid, a side chain of an aminoacid variant, a derivative of a side chain of an amino acid, or aderivative of a side chain of an amino acid variant that effects—C(O)—CH(R⁵)—N(R³)— to be a GI enzyme-cleavable moiety;

each R⁶ represents a side chain of an amino acid independently selectedfrom alanine, arginine, asparagine, aspartic acid, cysteine, glutamicacid, glutamine, glycine, histidine, isoleucine, leucine, lysine,methionine, phenylalanine, proline, serine, threonine, tryptophan,tyrosine and valine;

b is a number from zero to 100;

R⁷ is selected from hydrogen, alkyl, substituted alkyl, acyl,substituted acyl, alkoxycarbonyl, substituted alkoxycarbonyl, aryl,substituted aryl, arylalkyl, and substituted arylalkyl;

or a salt, hydrate or solvate thereof.

In formula VI and VIII-IX, X can be a residue of a phenolic opioid.

A “phenolic opioid” refers to a subset of the opioids that contain aphenol group. A phenolic opioid is a compound with a pharmacophore thatpresents to the opioid receptor an aromatic group and an aliphatic aminegroup in an architecturally discrete way. See, for example, Foye'sPrinciples of Medicinal Chemistry, Sixth Edition, ed. T. L. Lemke and D.A. Williams, Lippincott Williams & Wilkins, 2008, particularly Chapter24, pages 653-678.

For instance, the following opioids contain a phenol group that can be apoint of attachment to a promoiety: buprenorphine, dihydroetorphine,diprenorphine, etorphine, hydromorphone, levorphanol, morphine,nalbuphine, nalmefene, nalorphine, naloxone, naltrexone,N-methyldiprenorphine, N-methylnaloxone, N-methylnaltrexone, oripavine,oxymorphone, butorphanol, dezocine, ketobemidone, meptazinol,o-desmethyltramadol, pentazocine, phenazocine, and tapentadol.

In certain embodiments, the phenolic opioid is hydromorphone, morphine,oxymorphone, or tapentadol.

In certain embodiments, the phenolic opioid is naloxone, naltrexone,N-methylnaloxone, or N-methylnaltrexone. In certain embodiments, thephenolic opioid is diprenorphine or N-methyldiprenorphine.

In certain embodiments, the phenolic opioid is hydromorphone. In certainembodiments, the phenolic opioid is morphine. In certain embodiments,the phenolic opioid is oxymorphone. In certain embodiments, the phenolicopioid is tapentadol.

It is contemplated that opioids bearing at least some of thefunctionalities described herein will be developed; such opioids areincluded as part of the scope of this disclosure.

In formula VII, R^(a) can be hydrogen or hydroxyl. In certain instances,R^(a) is hydrogen. In other instances, R^(a) is hydroxyl.

In formula VII, R^(b) is hydrogen or alkyl. In certain instances, R^(b)is hydrogen. In other instances, R^(b) is alkyl.

Particular compound of interest, and salts or solvates or stereoisomersthereof, includes:

-   N-(Tapentadol-carbonyl)piperidine-2-methylamine-L-arginine-malonate    (Compound TP-5):

Amide-Modified Opioid Prodrugs

The disclosure provides an amide-modified opioid prodrug that providescontrolled release of an amide-containing opioid. As shown below, in anamide-modified opioid prodrug, a promoiety is attached to theamide-containing opioid through the enolic oxygen atom of the amide enolmoiety or through the oxygen of the imine tautomer. In an amide-modifiedopioid prodrug, the hydrogen atom of the corresponding enolic group ofthe amide enol or of the imine tautomer of the amide-containing opioidis replaced by a covalent bond to a promoiety. In certain embodiments,the promoiety that replaces the hydrogen atom of the correspondingenolic group of the amide enol or the imine tautomer of theamide-containing opioid contains an acyl group as the point ofconnection.

As disclosed herein, an enzyme-cleavable amide-modified opioid prodrugis an amide-modified opioid prodrug that comprises a promoietycomprising an enzyme-cleavable moiety, i.e., a moiety having a sitesusceptible to cleavage by an enzyme. Release of the opioid is mediatedby enzymatic cleavage of the promoiety from the amide-containing opioid.In one embodiment, the cleavable moiety is a GI enzyme-cleavable moiety,such as a trypsin-cleavable moiety.

Formulae X-XII

Compounds of the present disclosure include compounds of formulae X-XIIshown below. Compositions of the present disclosure also includecompounds of formulae X-XII shown below. Pharmaceutical compositions andmethods of the present disclosure also contemplate compounds of formulaeX-XII.

The present embodiments provide a compound of formula X:

wherein

X represents a residue of an amide-containing opioid, wherein —C(O)—N[(Aring)-Y_(c)]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷is connected to the amide-containing opioid through the oxygen of theamide group, wherein the amide group is converted to an amide enol or animine tautomer;

the A ring is a heterocyclic 5 to 12-membered ring;

each Y is independently selected from alkyl, substituted alkyl, alkenyl,substituted alkenyl, alkynyl, substituted alkynyl, aryl, substitutedaryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl, substitutedalkoxycarbonyl, aminoacyl, substituted aminoacyl, amino, substitutedamino, acylamino, substituted acylamino, and cyano;

c is a number from zero to 3;

each R¹ is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano;

each R² is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano; or

R¹ and R² together with the carbon to which they are attached can form acycloalkyl or substituted cycloalkyl group, or two R¹ or R² groups onadjacent carbon atoms, together with the carbon atoms to which they areattached, can form a cycloalkyl or substituted cycloalkyl group;

a is an integer from one to 8;

provided that when a is one, the A ring is a heterocyclic 6 to12-membered ring; and when the A ring is a heterocyclic 5-membered ring,then a is an integer from 2 to 8;

each R³ is independently hydrogen, alkyl, substituted alkyl, aryl orsubstituted aryl;

R⁵ is selected from hydrogen, alkyl, substituted alkyl, aryl,substituted aryl, arylalkyl, substituted arylalkyl, heteroalkyl,substituted heteroalkyl, heteroaryl, substituted heteroaryl,heteroarylalkyl, and substituted heteroarylalkyl;

each R⁶ is independently selected from hydrogen, alkyl, substitutedalkyl, aryl, substituted aryl, arylalkyl, substituted arylalkyl,heteroalkyl, substituted heteroalkyl, heteroaryl, substitutedheteroaryl, heteroarylalkyl, and substituted heteroarylalkyl;

b is a number from zero to 100;

R⁷ is selected from hydrogen, alkyl, substituted alkyl, acyl,substituted acyl, alkoxycarbonyl, substituted alkoxycarbonyl, aryl,substituted aryl, arylalkyl, and substituted arylalkyl;

or a salt, hydrate or solvate thereof.

The present embodiments provide a compound of formula XI:

wherein

X represents a residue of an amide-containing opioid, wherein —C(O)—N[(Aring)-Y_(c)]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—(CH(R⁶)—N(R²)]_(b)—R⁷is connected to the amide-containing opioid through the oxygen of theamide group, wherein the amide group is converted to an amide enol or animine tautomer;

the A ring is a heterocyclic 5 to 12-membered ring;

each Y is independently selected from alkyl, substituted alkyl, alkenyl,substituted alkenyl, alkynyl, substituted alkynyl, aryl, substitutedaryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl, substitutedalkoxycarbonyl, aminoacyl, substituted aminoacyl, amino, substitutedamino, acylamino, substituted acylamino, and cyano;

c is a number from zero to 3;

each R¹ is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano;

each R² is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano; or

R¹ and R² together with the carbon to which they are attached can form acycloalkyl or substituted cycloalkyl group, or two R¹ or R² groups onadjacent carbon atoms, together with the carbon atoms to which they areattached, can form a cycloalkyl or substituted cycloalkyl group;

a is an integer from one to 8;

provided that when a is one, the A ring is a heterocyclic 6 to12-membered ring; and when the A ring is a heterocyclic 5-membered ring,then a is an integer from 2 to 8;

each R³ is independently hydrogen, alkyl, substituted alkyl, aryl orsubstituted aryl;

R⁵ is a side chain of an amino acid selected from alanine, arginine,asparagine, aspartic acid, cysteine, glutamic acid, glutamine, glycine,histidine, isoleucine, leucine, lysine, methionine, phenylalanine,proline, serine, threonine, tryptophan, tyrosine, valine, homoarginine,homolysine, ornithine, arginine mimic, arginine homologue, argininetruncate, arginine with varying oxidation states, lysine mimic, lysinehomologue, lysine truncate, and lysine with varying oxidation states;

each R⁶ is a side chain of an amino acid independently selected fromalanine, arginine, asparagine, aspartic acid, cysteine, glutamic acid,glutamine, glycine, histidine, isoleucine, leucine, lysine, methionine,phenylalanine, proline, serine, threonine, tryptophan, tyrosine andvaline;

b is a number from zero to 100;

R⁷ is selected from hydrogen, alkyl, substituted alkyl, acyl,substituted acyl, alkoxycarbonyl, substituted alkoxycarbonyl, aryl,substituted aryl, arylalkyl, and substituted arylalkyl;

or a salt, hydrate or solvate thereof.

The present embodiments provide a compound of formula XII:

wherein

X represents a residue of an amide-containing opioid, wherein —C(O)—N[(Aring)-Y_(c)]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—H(R⁶)—N(R³)]_(b)—R⁷is connected to the amide-containing opioid through the oxygen of theamide group, wherein the amide group is converted to an amide enol or animine tautomer;

the A ring is a heterocyclic 5 to 12-membered ring;

each Y is independently selected from alkyl, substituted alkyl, alkenyl,substituted alkenyl, alkynyl, substituted alkynyl, aryl, substitutedaryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl, substitutedalkoxycarbonyl, aminoacyl, substituted aminoacyl, amino, substitutedamino, acylamino, substituted acylamino, and cyano;

c is a number from zero to 3;

each R¹ is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano;

each R² is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano; or

R¹ and R² together with the carbon to which they are attached can form acycloalkyl or substituted cycloalkyl group, or two R¹ or R² groups onadjacent carbon atoms, together with the carbon atoms to which they areattached, can form a cycloalkyl or substituted cycloalkyl group;

a is an integer from one to 8;

provided that when a is one, the A ring is a heterocyclic 6 to12-membered ring; and when the A ring is a heterocyclic 5-membered ring,then a is an integer from 2 to 8;

each R³ is independently hydrogen, alkyl, substituted alkyl, aryl orsubstituted aryl;

R⁵ represents a side chain of an amino acid, a side chain of an aminoacid variant, a derivative of a side chain of an amino acid, or aderivative of a side chain of an amino acid variant that effects—C(O)—CH(R⁵)—N(R³)— to be a GI enzyme-cleavable moiety;

each R⁶ represents a side chain of an amino acid independently selectedfrom alanine, arginine, asparagine, aspartic acid, cysteine, glutamicacid, glutamine, glycine, histidine, isoleucine, leucine, lysine,methionine, phenylalanine, proline, serine, threonine, tryptophan,tyrosine and valine;

b is a number from zero to 100;

R⁷ is selected from hydrogen, alkyl, substituted alkyl, acyl,substituted acyl, alkoxycarbonyl, substituted alkoxycarbonyl, aryl,substituted aryl, arylalkyl, and substituted arylalkyl;

or a salt, hydrate or solvate thereof.

In formula X-XII, X can be a residue of an amide-containing opioid,where the amide-containing opioid is connected through the oxygen of theamide group, wherein the amide group is converted to an amide enol or animine tautomer.

An “amide-containing opioid” refers to a subset of the opioids thatcontain an amide group. As used herein, an amide-containing opioid is anopioid containing an enolizable amide group. An amide-containing opioidis a compound with a pharmacophore that presents to the opioid receptoran aromatic group and an aliphatic amine group in an architecturallydiscrete way. See, for example, Foye's Principles of MedicinalChemistry, Sixth Edition, ed. T. L. Lemke and D. A. Williams, LippincottWilliams & Wilkins, 2008, particularly Chapter 24, pages 653-678.

For instance, the following opioids contain an amide group that can be apoint of attachment to a promoiety: alfentanil, carfentanil, fentanyl,lofentanil, loperamide, olmefentanyl, remifentanil, and sufentanil.

It is contemplated that opioids bearing at least some of thefunctionalities described herein will be developed; such opioids areincluded as part of the scope of this disclosure.

Compounds with Certain A Rings

Formulae XIII-XV

Compounds of the present disclosure include compounds of formulaeXIII-XV shown below. Compositions of the present disclosure also includecompounds of formulae XIII-XV shown below. Pharmaceutical compositionsand methods of the present disclosure also contemplate compounds offormulae XIII-XV.

The present embodiments provide a compound of formula XIII:

wherein

X is selected from a residue of a ketone-containing opioid, wherein thehydrogen atom of the corresponding hydroxyl group of the enolic tautomerof the ketone is replaced by a covalent bond to —C(O)—N[(Aring)-Y]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷; aresidue of a phenolic opioid, wherein the hydrogen atom of the phenolichydroxyl group is replaced by a covalent bond to —C(O)—N[(Aring)-Y]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷;and a residue of an amide-containing opioid, wherein —C(O)—N[(Aring)-Y]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷ isconnected to the amide-containing opioid through the oxygen of the amidegroup, wherein the amide group is converted to an amide enol or an iminetautomer;

A¹, A², A⁴, and A⁵ are independently selected from carbon, nitrogen,oxygen, and sulfur;

A³ is carbon or nitrogen;

each Y is independently selected from alkyl, substituted alkyl, alkenyl,substituted alkenyl, alkynyl, substituted alkynyl, aryl, substitutedaryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl, substitutedalkoxycarbonyl, aminoacyl, substituted aminoacyl, amino, substitutedamino, acylamino, substituted acylamino, and cyano;

each R¹ is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano;

each R² is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano; or

R¹ and R² together with the carbon to which they are attached can form acycloalkyl or substituted cycloalkyl group, or two R¹ or R² groups onadjacent carbon atoms, together with the carbon atoms to which they areattached, can form a cycloalkyl or substituted cycloalkyl group;

a is an integer from one to 8;

each R³ is independently hydrogen, alkyl, substituted alkyl, aryl orsubstituted aryl;

R⁵ is selected from hydrogen, alkyl, substituted alkyl, aryl,substituted aryl, arylalkyl, substituted arylalkyl, heteroalkyl,substituted heteroalkyl, heteroaryl, substituted heteroaryl,heteroarylalkyl, and substituted heteroarylalkyl;

each R⁶ is independently selected from hydrogen, alkyl, substitutedalkyl, aryl, substituted aryl, arylalkyl, substituted arylalkyl,heteroalkyl, substituted heteroalkyl, heteroaryl, substitutedheteroaryl, heteroarylalkyl, and substituted heteroarylalkyl;

b is a number from zero to 100; and

R⁷ is selected from hydrogen, alkyl, substituted alkyl, acyl,substituted acyl, alkoxycarbonyl, substituted alkoxycarbonyl, aryl,substituted aryl, arylalkyl, and substituted arylalkyl;

or a salt, hydrate or solvate thereof.

The present embodiments provide a compound of formula XIV:

wherein

X is selected from a residue of a ketone-containing opioid, wherein thehydrogen atom of the corresponding hydroxyl group of the enolic tautomerof the ketone is replaced by a covalent bond to —C(O)—N[(Aring)-Y]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷; aresidue of a phenolic opioid, wherein the hydrogen atom of the phenolichydroxyl group is replaced by a covalent bond to —C(O)—N[(Aring)-Y]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷;and a residue of an amide-containing opioid, wherein —C(O)—N[(Aring)-Y]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—(CH(R⁶)—N(R³)]_(b)—R⁷ isconnected to the amide-containing opioid through the oxygen of the amidegroup, wherein the amide group is converted to an amide enol or an iminetautomer;

A¹, A², A⁴, and A⁵ are independently selected from carbon, nitrogen,oxygen, and sulfur;

A³ is carbon or nitrogen;

Y is selected from alkyl, substituted alkyl, alkenyl, substitutedalkenyl, alkynyl, substituted alkynyl, aryl, substituted aryl, acyl,substituted acyl, carboxyl, alkoxycarbonyl, substituted alkoxycarbonyl,aminoacyl, substituted aminoacyl, amino, substituted amino, acylamino,substituted acylamino, and cyano;

each R¹ is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano;

each R² is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano; or

R¹ and R² together with the carbon to which they are attached can form acycloalkyl or substituted cycloalkyl group, or two R¹ or R² groups onadjacent carbon atoms, together with the carbon atoms to which they areattached, can form a cycloalkyl or substituted cycloalkyl group;

a is an integer from one to 8;

each R³ is independently hydrogen, alkyl, substituted alkyl, aryl orsubstituted aryl;

R⁵ is a side chain of an amino acid selected from alanine, arginine,asparagine, aspartic acid, cysteine, glutamic acid, glutamine, glycine,histidine, isoleucine, leucine, lysine, methionine, phenylalanine,proline, serine, threonine, tryptophan, tyrosine, valine, homoarginine,homolysine, ornithine, arginine mimic, arginine homologue, argininetruncate, arginine with varying oxidation states, lysine mimic, lysinehomologue, lysine truncate, and lysine with varying oxidation states;

each R⁶ is a side chain of an amino acid independently selected fromalanine, arginine, asparagine, aspartic acid, cysteine, glutamic acid,glutamine, glycine, histidine, isoleucine, leucine, lysine, methionine,phenylalanine, proline, serine, threonine, tryptophan, tyrosine andvaline;

b is a number from zero to 100;

R⁷ is selected from hydrogen, alkyl, substituted alkyl, acyl,substituted acyl, alkoxycarbonyl, substituted alkoxycarbonyl, aryl,substituted aryl, arylalkyl, and substituted arylalkyl;

or a salt, hydrate or solvate thereof.

The present embodiments provide a compound of formula XV:

wherein

X is selected from a residue of a ketone-containing opioid, wherein thehydrogen atom of the corresponding hydroxyl group of the enolic tautomerof the ketone is replaced by a covalent bond to —C(O)—N[(Aring)-Y]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷; aresidue of a phenolic opioid, wherein the hydrogen atom of the phenolichydroxyl group is replaced by a covalent bond to —C(O)—N[(Aring)-Y]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷;and a residue of an amide-containing opioid, wherein —C(O)—N[(Aring)-Y]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—(CH(R⁶)—N(R³)]_(b)—R⁷ isconnected to the amide-containing opioid through the oxygen of the amidegroup, wherein the amide group is converted to an amide enol or an iminetautomer;

A¹, A², A⁴, and A⁵ are independently selected from carbon, nitrogen,oxygen, and sulfur;

A³ is carbon or nitrogen;

Y is selected from alkyl, substituted alkyl, alkenyl, substitutedalkenyl, alkynyl, substituted alkynyl, aryl, substituted aryl, acyl,substituted acyl, carboxyl, alkoxycarbonyl, substituted alkoxycarbonyl,aminoacyl, substituted aminoacyl, amino, substituted amino, acylamino,substituted acylamino, and cyano;

each R¹ is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano;

each R² is independently selected from hydrogen, alkyl, substitutedalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, aryl,substituted aryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl,substituted alkoxycarbonyl, aminoacyl, substituted aminoacyl, amino,substituted amino, acylamino, substituted acylamino, and cyano; or

R¹ and R² together with the carbon to which they are attached can form acycloalkyl or substituted cycloalkyl group, or two R¹ or R² groups onadjacent carbon atoms, together with the carbon atoms to which they areattached, can form a cycloalkyl or substituted cycloalkyl group;

a is an integer from one to 8;

each R³ is independently hydrogen, alkyl, substituted alkyl, aryl orsubstituted aryl;

R⁵ represents a side chain of an amino acid, a side chain of an aminoacid variant, a derivative of a side chain of an amino acid, or aderivative of a side chain of an amino acid variant that effects—C(O)—CH(R⁵)—N(R³)— to be a GI enzyme-cleavable moiety;

each R⁶ represents a side chain of an amino acid independently selectedfrom alanine, arginine, asparagine, aspartic acid, cysteine, glutamicacid, glutamine, glycine, histidine, isoleucine, leucine, lysine,methionine, phenylalanine, proline, serine, threonine, tryptophan,tyrosine and valine;

b is a number from zero to 100;

R⁷ is selected from hydrogen, alkyl, substituted alkyl, acyl,substituted acyl, alkoxycarbonyl, substituted alkoxycarbonyl, aryl,substituted aryl, arylalkyl, and substituted arylalkyl;

or a salt, hydrate or solvate thereof.

In formulae XIII-XV, X can be selected from a residue of aketone-containing opioid, wherein the hydrogen atom of the correspondinghydroxyl group of the enolic tautomer of the ketone is replaced by acovalent bond to —C(O)—N[(Aring)-Y]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷; aresidue of a phenolic opioid, wherein the hydrogen atom of the phenolichydroxyl group is replaced by a covalent bond to —C(O)—N[(Aring)-Y]—(CR¹R²)_(a)— NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷;and a residue of an amide-containing opioid, wherein —C(O)—N[(Aring)-Y]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷ isconnected to the amide-containing opioid through the oxygen of the amidegroup, wherein the amide group is converted to an amide enol or an iminetautomer.

In certain instances, X is a ketone-containing opioid, wherein thehydrogen atom of the corresponding hydroxyl group of the enolic tautomerof the ketone is replaced by a covalent bond to —C(O)—N[(Aring)-Y]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷.

In certain instances, X is a ketone-containing opioid, wherein theopioid is selected from acetylmorphone, hydrocodone, hydromorphone,ketobemidone, methadone, naloxone, naltrexone, N-methylnaloxone,N-methylnaltrexone, oxycodone, oxymorphone, and pentamorphone.

In certain instances, X is a residue of a phenolic opioid, wherein thehydrogen atom of the phenolic hydroxyl group is replaced by a covalentbond to —C(O)—N[(Aring)-Y]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷.

In certain instances, X is a phenolic opioid, wherein the opioid isselected from buprenorphine, dihydroetorphine, diprenorphine, etorphine,hydromorphone, levorphanol, morphine, nalbuphine, nalmefene, nalorphine,naloxone, naltrexone, N-methyldiprenorphine, N-methylnaloxone,N-methylnaltrexone, oripavine, oxymorphone, butorphanol, dezocine,ketobemidone, meptazinol, o-desmethyltramadol, pentazocine, phenazocine,and tapentadol.

In certain instances, X is a residue of an amide-containing opioid,wherein —C(O)—N[(Aring)-Y]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷ isconnected to the amide-containing opioid through the oxygen of the amidegroup, wherein the amide group is converted to an amide enol or an iminetautomer.

In certain instances, X is an amide-containing opioid, wherein theopioid is selected from alfentanil, carfentanil, fentanyl, lofentanil,loperamide, olmefentanyl, remifentanil, and sufentanil.

In formulae XIII-XV, A¹, A², A⁴, and A⁵ are independently selected fromcarbon, nitrogen, oxygen, and sulfur. In certain instances, A¹, A², A⁴,and A⁵ are independently selected from carbon and nitrogen. In certaininstances, A¹, A², A⁴, and A⁵ are independently selected from carbon andoxygen. In certain instances, A¹, A², A⁴, and A⁵ are independentlyselected from carbon and sulfur. In certain instances, A¹, A², A⁴, andA⁵ are carbon.

In formulae XIII-XV, A³ is carbon or nitrogen. In certain instances, A³is carbon. In certain instances, A³ is nitrogen.

In certain instances,—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷ is attachedto A¹. In certain instances,—(CR¹R²)_(a)—NH—C(O)—CH(R—)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷ is attachedto A². In certain instances,—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷ is attachedto A⁴. In certain instances,—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)]_(b)—R⁷ is attachedto A⁵.

Certain Embodiments of Formulae I-XV

In formulae I-XII, the A ring can be a heterocyclic 5 to 12-memberedring.

In certain instances, the A ring is a heterocyclic 5 to 11-memberedring. In certain instances, the A ring is a heterocyclic 5 to10-membered ring. In certain instances, the A ring is a heterocyclic 5to 9-membered ring. In certain instances, the A ring is a heterocyclic 5to 8-membered ring. In certain instances, the A ring is a heterocyclic 5to 7-membered ring. In certain instances, the A ring is a heterocyclic 5or 6-membered ring. In certain instances, the A ring is a heterocyclic5-membered ring.

In certain instances, the A ring is a heterocyclic 6 to 12-memberedring. In certain instances, the A ring is a heterocyclic 6 to11-membered ring. In certain instances, the A ring is a heterocyclic 6to 10-membered ring. In certain instances, the A ring is a heterocyclic6 to 9-membered ring. In certain instances, the A ring is a heterocyclic6 to 8-membered ring. In certain instances, the A ring is a heterocyclic6 or 7-membered ring. In certain instances, the A ring is a heterocyclic6-membered ring. In certain instances, the A ring is a heterocyclic7-membered ring. In certain instances, the A ring is a heterocyclic8-membered ring.

In formulae I-XII, c can be a number from zero to 3. In certaininstances, c is zero. In certain instances, c is 1. In certaininstances, c is 2. In certain instances, c is 3.

In formulae I-XV, each Y is independently selected from alkyl,substituted alkyl, alkenyl, substituted alkenyl, alkynyl, substitutedalkynyl, aryl, substituted aryl, acyl, substituted acyl, carboxyl,alkoxycarbonyl, substituted alkoxycarbonyl, aminoacyl, substitutedaminoacyl, amino, substituted amino, acylamino, substituted acylamino,and cyano.

In formulae I-XV, Y can be carboxyl or amino. In certain instances, Y iscarboxyl. In certain instances, Y is amino.

In certain instances, Y is alkyl or substituted alkyl. In certaininstances, Y is alkyl. In certain instances, Y is substituted alkyl. Incertain instances, Y is alkenyl or substituted alkenyl.

In certain instances, Y is alkenyl. In certain instances, Y issubstituted alkenyl. In certain instances, Y is alkynyl or substitutedalkynyl. In certain instances, Y is alkynyl. In certain instances, Y issubstituted alkynyl. In certain instances, Y is aryl or substitutedaryl. In certain instances, Y is aryl. In certain instances, Y issubstituted aryl.

In certain instances, Y is acyl or substituted acyl. In certaininstances, Y is acyl. In certain instances, Y is substituted acyl. Incertain instances, Y is carboxyl. In certain instances, Y isalkoxycarbonyl or substituted alkoxycarbonyl. In certain instances, Y isalkoxycarbonyl. In certain instances, Y is substituted alkoxycarbonyl.In certain instances, Y is aminoacyl or substituted aminoacyl. Incertain instances, Y is aminoacyl. In certain instances, Y issubstituted aminoacyl. In certain instances, Y is amino or substitutedamino. In certain instances, Y is amino. In certain instances, Y issubstituted amino. In certain instances, Y is acylamino or substitutedacylamino. In certain instances, Y is acylamino. In certain instances, Yis substituted acylamino. In certain instances, Y is cyano.

In certain instances, Y is substituted alkyl. In certain instances, Y isan alkyl group substituted with a carboxylic group such as a carboxylicacid, alkoxycarbonyl or aminoacyl. In certain instances, Y is—(CH₂)_(q)(C₆H₄)—COOH, —(CH₂)_(q)(C₆H₄)—COOCH₃, or—(CH₂)_(q)(C₆H₄)—COOCH₂CH₃, where q is an integer from one to 10. Incertain instances, Y is aminoacyl. In certain instances, Y is an alkylgroup substituted with an amino group, substituted amino, or acylamino.

In certain instances, Y is aminoacyl or substituted aminoacyl.

In certain instances, Y is aminoacyl comprising phenylenediamine. Incertain instances,

wherein each R¹⁰ is independently selected from hydrogen, alkyl,substituted alkyl, and acyl and R¹¹ is alkyl or substituted alkyl. Incertain instances, at least one of R¹⁰ is acyl. In certain instances, atleast one of R¹⁰ is alkyl or substituted alkyl. In certain instances, atleast one of R¹⁰ is hydrogen. In certain instances, both of R¹⁰ arehydrogen.

In certain instances,

wherein R¹⁰ is hydrogen, alkyl, substituted alkyl, or acyl. In certaininstances, R¹⁰ is acyl. In certain instances, R¹⁰ is alkyl orsubstituted alkyl. In certain instances, R¹⁰ is hydrogen.

In certain instances,

wherein each R¹⁰ is independently hydrogen, alkyl, substituted alkyl, oracyl and b is a number from one to 5. In certain instances,

wherein each R¹⁰ is independently hydrogen, alkyl, substituted alkyl, oracyl. In certain instances,

wherein R^(10a) is alkyl and each R¹⁰ is independently hydrogen, alkyl,substituted alkyl, or acyl.

In certain instances,

wherein R¹⁰ is independently hydrogen, alkyl, substituted alkyl, or acyland b is a number from one to 5. In certain instances,

wherein R¹⁰ is independently hydrogen, alkyl, substituted alkyl, oracyl.

In certain instances, Y is an aminoacyl group, such as—C(O)NR^(10a)R^(10b), wherein each R^(10a) and R^(10b) is independentlyselected from hydrogen, alkyl, substituted alkyl, and acyl. In certaininstances, Y is an aminoacyl group, such as —C(O)NR^(10a)R^(10b),wherein R^(10a) is an alkyl and R^(10b) is substituted alkyl. In certaininstances, Y is an aminoacyl group, such as —C(O)NR^(a)R^(10b) whereinR^(10a) is an alkyl and R^(10b) is alkyl substituted with a carboxylicacid or alkoxycarbonyl. In certain instances, Y is an aminoacyl group,such as —C(O)NR^(10a)R^(10b), wherein R^(10a) is methyl and R^(10b) isalkyl substituted with a carboxylic acid or alkoxycarbonyl.

In certain instances, Y is carboxyl.

In certain instances, Y is acyl or substituted acyl.

In certain instances, Y is alkoxycarbonyl or substituted alkoxycarbonyl.

In certain instances, Y is amino or substituted amino.

In certain instances, Y is acylamino or substituted acylamino.

In formulae I-XV, a can be an integer from one to 8. In certaininstances, a is one. In certain instances, a is 2. In certain instances,a is 3. In certain instances, a is 4. In certain instances, a is 5. Incertain instances, a is 6. In certain instances, a is 7. In certaininstances, a is 8.

In formulae I-XV, each R¹ is independently selected from hydrogen,alkyl, substituted alkyl, alkenyl, substituted alkenyl, alkynyl,substituted alkynyl, aryl, substituted aryl, acyl, substituted acyl,carboxyl, alkoxycarbonyl, substituted alkoxycarbonyl, aminoacyl,substituted aminoacyl, amino, substituted amino, acylamino, substitutedacylamino, and cyano.

In certain instances, R¹ is hydrogen. In certain instances, R¹ is alkylor substituted alkyl. In certain instances, R¹ is alkyl. In certaininstances, R¹ is substituted alkyl. In certain instances, R¹ is alkenylor substituted alkenyl. In certain instances, R¹ is alkenyl. In certaininstances, R¹ is substituted alkenyl. In certain instances, R¹ isalkynyl or substituted alkynyl. In certain instances, R¹ is alkynyl. Incertain instances, R¹ is substituted alkynyl. In certain instances, R¹is aryl or substituted aryl. In certain instances, R¹ is aryl. Incertain instances, R¹ is substituted aryl.

In certain instances, R¹ is acyl or substituted acyl. In certaininstances, R¹ is acyl. In certain instances, R¹ is substituted acyl. Incertain instances, R¹ is carboxyl. In certain instances, R¹ isalkoxycarbonyl or substituted alkoxycarbonyl. In certain instances, R¹is alkoxycarbonyl. In certain instances, R¹ is substitutedalkoxycarbonyl. In certain instances, R¹ is aminoacyl or substitutedaminoacyl. In certain instances, R¹ is aminoacyl. In certain instances,R¹ is substituted aminoacyl. In certain instances, R¹ is amino orsubstituted amino. In certain instances, R¹ is amino. In certaininstances, R¹ is substituted amino. In certain instances, R¹ isacylamino or substituted acylamino. In certain instances, R¹ isacylamino. In certain instances, R¹ is substituted acylamino. In certaininstances, R¹ is cyano.

In formulae I-XV, each R² is independently selected from hydrogen,alkyl, substituted alkyl, alkenyl, substituted alkenyl, alkynyl,substituted alkynyl, aryl, substituted aryl, acyl, substituted acyl,carboxyl, alkoxycarbonyl, substituted alkoxycarbonyl, aminoacyl,substituted aminoacyl, amino, substituted amino, acylamino, substitutedacylamino, and cyano.

In certain instances, R² is hydrogen. In certain instances, R² is alkylor substituted alkyl. In certain instances, R² is alkyl. In certaininstances, R² is substituted alkyl. In certain instances, R² is alkenylor substituted alkenyl. In certain instances, R² is alkenyl. In certaininstances, R² is substituted alkenyl. In certain instances, R² isalkynyl or substituted alkynyl. In certain instances, R² is alkynyl. Incertain instances, R² is substituted alkynyl. In certain instances, R²is aryl or substituted aryl. In certain instances, R² is aryl. Incertain instances, R² is substituted aryl. In certain instances, R² isacyl or substituted acyl. In certain instances, R² is acyl. In certaininstances, R² is substituted acyl. In certain instances, R² is carboxyl.In certain instances, R² is alkoxycarbonyl or substitutedalkoxycarbonyl. In certain instances, R² is alkoxycarbonyl. In certaininstances, R² is substituted alkoxycarbonyl. In certain instances, R² isaminoacyl or substituted aminoacyl. In certain instances, R² isaminoacyl. In certain instances, R² is substituted aminoacyl. In certaininstances, R² is amino or substituted amino. In certain instances, R² isamino. In certain instances, R² is substituted amino. In certaininstances, R² is acylamino or substituted acylamino. In certaininstances, R² is acylamino. In certain instances, R² is substitutedacylamino. In certain instances, R² is cyano.

In certain instances, one of R¹ and R² is hydrogen. In certaininstances, one of R¹ and R² is alkyl. In certain instances, one of R¹and R² is substituted alkyl. In certain instances, one of R¹ and R² isalkenyl or substituted alkenyl. In certain instances, one of R¹ and R²is alkynyl or substituted alkynyl. In certain instances, one of R¹ andR² is aryl or substituted aryl. In certain instances, one of R¹ and R²is acyl or substituted acyl. In certain instances, one of R¹ and R² iscarboxyl. In certain instances, one of R¹ and R² is alkoxycarbonyl orsubstituted alkoxycarbonyl. In certain instances, one of R¹ and R² isaminoacyl or substituted aminoacyl. In certain instances, one of R¹ andR² is amino or substituted amino. In certain instances, one of R¹ and R²is acylamino or substituted acylamino. In certain instances, one of R¹and R² is cyano.

In certain instances, R¹ and R² are hydrogen. In certain instances, R¹and R² on the same carbon are both alkyl. In certain instances, R¹ andR² on the same carbon are methyl. In certain instances, R¹ and R² on thesame carbon are ethyl.

In certain instances, R¹ and R¹ which are vicinal are both alkyl and R²and R² which are vicinal are both hydrogen. In certain instances, R¹ andR¹ which are vicinal are both ethyl and R² and R² which are vicinal areboth hydrogen. In certain instances, R¹ and R¹ which are vicinal areboth methyl and R² and R² which are vicinal are both hydrogen.

In certain instances, in the chain of —[C(R¹)(R²)]_(a)—, not everycarbon is substituted. In certain instances, in the chain of—[C(R¹)(R²)]_(a)—, there is a combination of different alkylsubstituents, such as methyl or ethyl.

In certain instances, one or both of R¹ and R² is substituted alkyl. Incertain instances, one or both of R¹ and R² is an alkyl groupsubstituted with a carboxylic group such as a carboxylic acid,alkoxycarbonyl or aminoacyl. In certain instances, one or both of R¹ andR² is —(CH₂)_(q)(C₆H₄)—COOH, —(CH₂)_(q)(C₆H₄)—COOCH₃, or—(CH₂)_(q)(C₆H₄)—COOCH₂CH₃, where q is an integer from one to 10. Incertain instances, one or both of R¹ and R² is aminoacyl.

In formulae I-XV, R¹ and R² together with the carbon to which they areattached can form a cycloalkyl or substituted cycloalkyl group, or twoR¹ or R² groups on adjacent carbon atoms, together with the carbon atomsto which they are attached, can form a cycloalkyl or substitutedcycloalkyl group. In certain instances, R¹ and R² together with thecarbon to which they are attached can form a cycloalkyl group. Thus, incertain instances, R¹ and R² on the same carbon form a spirocycle. Incertain instances, R¹ and R² together with the carbon to which they areattached can form a substituted cycloalkyl group. In certain instances,two R¹ or R² groups on adjacent carbon atoms, together with the carbonatoms to which they are attached, can form a cycloalkyl group. Incertain instances, two R¹ or R² groups on adjacent carbon atoms,together with the carbon atoms to which they are attached, can form asubstituted cycloalkyl group.

In certain instances, one of R¹ and R² is aminoacyl.

In certain instances, one of R¹ and R² is aminoacyl comprisingphenylenediamine. In certain instances, one or both of R¹ and

wherein each R¹⁰ is independently selected from hydrogen, alkyl,substituted alkyl, and acyl and R¹¹ is alkyl or substituted alkyl. Incertain instances, at least one of R¹⁰ is acyl. In certain instances, atleast one of R¹⁰ is alkyl or substituted alkyl. In certain instances, atleast one of R¹⁰ is hydrogen. In certain instances, both of R¹⁰ arehydrogen.

In certain instances, one of R¹ and

wherein R¹⁰ is hydrogen, alkyl, substituted alkyl, or acyl. In certaininstances, R¹⁰ is acyl. In certain instances, R¹⁰ is alkyl orsubstituted alkyl. In certain instances, R¹⁰ is hydrogen.

In certain instances, one of R¹ and

wherein each R¹⁰ is independently hydrogen, alkyl, substituted alkyl, oracyl and b is a number from one to 5. In certain instances, one of R¹and

wherein each R¹⁰ is independently hydrogen, alkyl, substituted alkyl, oracyl. In certain instances, one of R¹ and

wherein R^(10a) is alkyl and each R¹⁰ is independently hydrogen, alkyl,substituted alkyl, or acyl.

In certain instances, one of R¹ and

wherein R¹⁰ is independently hydrogen, alkyl, substituted alkyl, or acyland b is a number from one to 5. In certain instances, one of R¹ and

wherein R¹⁰ is independently hydrogen, alkyl, substituted alkyl, oracyl.

In certain instances, one of R¹ and R² is an aminoacyl group, such as—C(O)NR^(10a)R^(10b) wherein each R^(10a) and R^(10b) is independentlyselected from hydrogen, alkyl, substituted alkyl, and acyl. In certaininstances, one of R¹ and R² is an aminoacyl group, such as—C(O)NR^(a)R^(10b) wherein R^(10a) is an alkyl and R^(10b) issubstituted alkyl. In certain instances, one of R¹ and R² is anaminoacyl group, such as —C(O)NR^(10a)R^(10b), wherein R^(10a) is analkyl and R^(10b) is alkyl substituted with a carboxylic acid oralkoxycarbonyl. In certain instances, one of R¹ and R² is an aminoacylgroup, such as —C(O)NR^(10a)R^(10b), wherein R^(10a) is methyl andR^(10b) is alkyl substituted with a carboxylic acid or alkoxycarbonyl.

In certain instances, one of R¹ and R² are carboxyl.

In certain instances, one of R¹ and R² is acyl or substituted acyl.

In certain instances, one of R¹ and R² is alkoxycarbonyl or substitutedalkoxycarbonyl.

In certain instances, one of R¹ and R² is amino or substituted amino.

In certain instances, one of R¹ and R² is acylamino or substitutedacylamino.

In certain instances, R¹ or R² can modulate a rate of intramolecularcyclization. R¹ or R² can speed up a rate of intramolecular cyclization,when compared to the corresponding molecule where R¹ and R² are bothhydrogen. In certain instances, R¹ or R² comprise anelectron-withdrawing group or an electron-donating group. In certaininstances, R¹ or R² comprise an electron-withdrawing group. In certaininstances, R¹ or R² comprise an electron-donating group.

Atoms and groups capable of functioning as electron-withdrawingsubstituents are well known in the field of organic chemistry. Theyinclude electronegative atoms and groups containing electronegativeatoms. Such groups function to lower the basicity or protonation stateof a nucleophilic nitrogen in the beta position via inductive withdrawalof electron density. Such groups can also be positioned on otherpositions along the alkylene chain. Examples include halogen atoms (forexample, a fluorine atom), acyl groups (for example an alkanoyl group,an aroyl group, a carboxyl group, an alkoxycarbonyl group, anaryloxycarbonyl group or an aminocarbonyl group (such as a carbamoyl,alkylaminocarbonyl, dialkylaminocarbonyl or arylaminocarbonyl group)),an oxo (═O) substituent, a nitrile group, a nitro group, ether groups(for example an alkoxy group) and phenyl groups bearing a substituent atthe ortho position, the para position or both the ortho and the parapositions, each substituent being selected independently from a halogenatom, a fluoroalkyl group (such as trifluoromethyl), a nitro group, acyano group and a carboxyl group. Each of the electron withdrawingsubstituents can be selected independently from these.

In certain instances, —[C(R¹)(R²)]_(a)— is selected from—CH(CH₂F)CH(CH₂F)—; —CH(CHF₂)CH(CHF₂)—; —CH(CF₃)CH(CF₃)—; —CH₂CH(CF₃)—;—CH₂CH(CHF₂)—; —CH₂CH(CH₂F)—; —CH₂CH(F)CH₂—; —CH₂C(F₂)CH₂—;—CH₂CH(C(O)NR²⁰R²¹)—; —CH₂CH(C(O)OR²²)—; —CH₂CH(C(O)OH)—;—CH(CH₂F)CH₂CH(CH₂F)—; —CH(CHF₂)CH₂CH(CHF₂)—; —CH(CF₃)CH₂CH(CF₃)—;—CH₂CH₂CH(CF₃)—; —CH₂CH₂CH(CHF₂)—; —CH₂CH₂CH(CH₂F)—;—CH₂CH₂CH(C(O)NR²³R²⁴)—; —CH₂CH₂CH(C(O)OR²⁵)—; and —CH₂CH₂CH(C(O)OH)—,in which R²⁰, R²¹, R²² and R²³ each independently represents hydrogen or(1-6C)alkyl, and R²⁴ and R²⁵ each independently represents (1-6C)alkyl.

In formulae I-XII, when a is one, the A ring is a heterocyclic 6 to12-membered ring; and when the A ring is a heterocyclic 5-membered ring,then a is an integer from 2 to 8.

In certain instances, when a is one, the A ring is a heterocyclic 6 to11-membered ring. In certain instances, when a is one, the A ring is aheterocyclic 6 to 10-membered ring. In certain instances, when a is one,the A ring is a heterocyclic 6 to 9-membered ring. In certain instances,when a is one, the A ring is a heterocyclic 6 to 8-membered ring. Incertain instances, when a is one, the A ring is a heterocyclic 6 to7-membered ring. In certain instances, when a is one, the A ring is aheterocyclic 6-membered ring.

In certain instances, when the A ring is a heterocyclic 5-membered ring,then a is an integer from 2 to 7. In certain instances, when the A ringis a heterocyclic 5-membered ring, then a is an integer from 2 to 6. Incertain instances, when the A ring is a heterocyclic 5-membered ring,then a is an integer from 2 to 5. In certain instances, when the A ringis a heterocyclic 5-membered ring, then a is an integer from 2 to 4. Incertain instances, when the A ring is a heterocyclic 5-membered ring,then a is an integer from 2 to 3. In certain instances, when the A ringis a heterocyclic 5-membered ring, then a is 2.

In certain instances, the A ring is a heterocyclic 7-membered or8-membered ring and a is 1 or 2. In certain instances, the A ring is aheterocyclic 7-membered ring and a is 1. In certain instances, the Aring is a heterocyclic 7-membered ring and a is 2. In certain instances,the A ring is a heterocyclic 8-membered ring and a is 1. In certaininstances, the A ring is a heterocyclic 8-membered ring and a is 2.

In certain instances, a certain group of compounds are compounds offormulae I-XII, wherein A ring is a 5-membered ring and a is 2. Acertain group of compounds are compounds of formulae I-XII, wherein Aring is a 6-membered ring and a is one.

In formulae I-XV, each R³ can independently be hydrogen, alkyl,substituted alkyl, aryl or substituted aryl.

In certain instances, at least one R³ is hydrogen. In certain instances,at least one R³ is alkyl. In certain instances, at least one R³ issubstituted alkyl. In certain instances, at least one R³ is aryl. Incertain instances, at least one R³ is substituted aryl.

In certain instances, each of the R³ is hydrogen or alkyl. In certaininstances, all R³ are hydrogen. In certain instances, all R³ are alkyl.In certain instances, the R³ of N—R³ that is adjacent to C—R⁵ ishydrogen or alkyl. In certain instances, the R³ of N—R³ that is adjacentto C—R⁵ is hydrogen. In certain instances, the R³ of N—R³ that isadjacent to C—R⁵ is alkyl.

In formulae I-III, VI-VII, X, and XIII, R⁵ can be selected fromhydrogen, alkyl, substituted alkyl, aryl, substituted aryl, arylalkyl,substituted arylalkyl, heteroalkyl, substituted heteroalkyl, heteroaryl,substituted heteroaryl, heteroarylalkyl, and substitutedheteroarylalkyl.

In certain instances, in formulae I-III, VI-VII, X, and XIII, R⁵ isselected from hydrogen, alkyl, substituted alkyl, aryl, substitutedaryl, arylalkyl, substituted arylalkyl, heteroalkyl, substitutedheteroalkyl, heteroaryl, substituted heteroaryl, heteroarylalkyl, andsubstituted heteroarylalkyl. In certain instances, R⁵ is selected fromhydrogen, alkyl, substituted alkyl, arylalkyl, substituted arylalkyl,heteroarylalkyl, and substituted heteroarylalkyl. In certain instances,R⁵ is hydrogen. In certain instances, R⁵ is alkyl. In certain instances,R⁵ is substituted alkyl. In certain instances, R⁵ is arylalkyl orsubstituted arylalkyl. In certain instances, R⁵ is heteroarylalkyl orsubstituted heteroarylalkyl.

In certain instances, in formulae I-III, VI-VII, X, and XIII, R⁵ is aside chain of an amino acid, a side chain of an amino acid variant, aderivative of a side chain of an amino acid, or a derivative of a sidechain of an amino acid variant.

In formulae IV, VIII, XI, and XIV, R⁵ can be a side chain of an aminoacid selected from alanine, arginine, asparagine, aspartic acid,cysteine, glutamic acid, glutamine, glycine, histidine, isoleucine,leucine, lysine, methionine, phenylalanine, proline, serine, threonine,tryptophan, tyrosine, valine, homoarginine, homolysine, ornithine,arginine mimic, arginine homologue, arginine truncate, arginine withvarying oxidation states, lysine mimic, lysine homologue, lysinetruncate, and lysine with varying oxidation states.

In certain instances, R⁵ can be a side chain of an amino acid selectedfrom alanine, arginine, asparagine, aspartic acid, cysteine, glutamicacid, glutamine, glycine, histidine, isoleucine, leucine, lysine,methionine, phenylalanine, proline, serine, threonine, tryptophan,tyrosine, and valine.

In certain instances, R⁵ is a side chain of an L-amino acid selectedfrom L-alanine, L-arginine, L-asparagine, L-aspartic acid, L-cysteine,L-glutamic acid, L-glutamine, glycine, L-histidine, L-isoleucine,L-leucine, L-lysine, L-methionine, L-phenylalanine, L-proline, L-serine,L-threonine, L-tryptophan, L-tyrosine, L-valine, L-homoarginine,L-homolysine, L-ornithine, L-arginine mimic, L-arginine homologue,L-arginine truncate, L-arginine with varying oxidation states, L-lysinemimic, L-lysine homologue, L-lysine truncate, and L-lysine with varyingoxidation states.

In certain instances, R⁵ is a side chain of an L-amino acid selectedfrom L-alanine, L-arginine, L-asparagine, L-aspartic acid, L-cysteine,L-glutamic acid, L-glutamine, glycine, L-histidine, L-isoleucine,L-leucine, L-lysine, L-methionine, L-phenylalanine, L-proline, L-serine,L-threonine, L-tryptophan, L-tyrosine, and L-valine.

In certain instances, R⁵ is a side chain of an amino acid selected fromarginine, lysine, homoarginine, homolysine, ornithine, arginine mimic,arginine homologue, arginine truncate, arginine with varying oxidationstates, lysine mimic, lysine homologue, lysine truncate, and lysine withvarying oxidation states. Examples of arginine and lysine mimics includearylguanidines, arylamidines (substituted benzamidines), benzylaminesand (bicyclo[2.2.2]octan-1-yl)methanamine, citrulline, homocitrullineand derivatives thereof. In certain instances, R⁵ is a side chain of anamino acid selected from arginine, lysine, homoarginine, homolysine, andornithine. In certain instances, R⁵ is a side chain of an amino acidselected from arginine or lysine. In certain instances, R⁵ is a sidechain of arginine. In certain instances, R⁵ is a side chain of lysine.

In certain instances, R⁵ is a side chain of an L-amino acid selectedfrom L-arginine, L-lysine, L-homoarginine, L-homolysine, L-ornithine,L-arginine mimic, L-arginine homologue, L-arginine truncate, L-argininewith varying oxidation states, L-lysine mimic, L-lysine homologue,L-lysine truncate, and L-lysine with varying oxidation states. Incertain instances, R⁵ is a side chain of an L-amino acid selected fromL-arginine, L-lysine, L-homoarginine, L-homolysine, and L-ornithine. Incertain instances, R⁵ is a side chain of an L-amino acid selected fromL-arginine or L-lysine. In certain instances, R⁵ is a side chain ofL-arginine. In certain instances, R⁵ is a side chain of L-lysine.

In certain instances, R⁵

represents —CH₂CH₂CH₂NH(C(═NH)(NH₂)) or —CH₂CH₂CH₂CH₂NH₂, theconfiguration of the carbon atom to which R⁵ is attached correspondingwith that in an L-amino acid.

In formulae V, IX, XII, and XV, R⁵ can be a side chain of an amino acid,a side chain of an amino acid variant, a derivative of a side chain ofan amino acid, or a derivative of a side chain of an amino acid variantthat effects —C(O)—C(R⁵)—N(R³)— to be a GI enzyme-cleavable moiety, suchas a trypsin-cleavable moiety. A GI enzyme-cleavable moiety is astructural moiety that is capable of being cleaved by a GI enzyme. Atrypsin-cleavable moiety is a structural moiety that is capable of beingcleaved by trypsin. In certain instances, a GI enzyme-cleavable moietycomprises a charged moiety that can fit into an active site of a GIenzyme and is able to orient the prodrug for cleavage at a scissilebond. In certain instances, a trypsin-cleavable moiety comprises acharged moiety that can fit into an active site of trypsin and is ableto orient the prodrug for cleavage at a scissile bond. For instance, thecharged moiety of a GI enzyme-cleavable moiety, such as atrypsin-cleavable moiety, can be a basic moiety that exists as a chargedmoiety at physiological pH. A derivative of an amino acid or of an aminoacid variant refers to a substance that has been altered from anothersubstance by modification, partial substitution, homologation,truncation, or a change in oxidation state, while retaining the abilityto be cleaved by a GI enzyme.

For example, to form a trypsin-cleavable moiety, R⁵ can include, but isnot limited to, a side chain of lysine (such as L-lysine), arginine(such as L-arginine), homolysine, homoarginine, and ornithine. Othervalues for R⁵ include, but are not limited to, a side chain of anarginine mimic, arginine homologue, arginine truncate, arginine withvarying oxidation states (for instance, metabolites), lysine mimic,lysine homologue, lysine truncate, and lysine with varying oxidationstates (for instance, metabolites). Examples of arginine and lysinemimics include arylguanidines, arylamidines (substituted benzamidines),benzylamines, (bicyclo[2.2.2]octan-1-yl)methanamine, citrulline,homocitrulline and derivatives thereof.

In certain instances, R⁵ is a side chain of an amino acid that effects—C(O)—C(R⁵)—N(R³)— to be a GI enzyme-cleavable moiety, such as atrypsin-cleavable moiety. In certain instances, R⁵ is a side chain of anamino acid variant that effects —C(O)—C(R⁵)—N(R³)— to be a GIenzyme-cleavable moiety, such as a trypsin-cleavable moiety. In certaininstances, R⁵ is a derivative of a side chain of an amino acid thateffects —C(O)—C(R⁵)—N(R³)— to be a GI enzyme-cleavable moiety, such as atrypsin-cleavable moiety. In certain instances, R⁵ is a derivative of aside chain of an amino acid variant that effects —C(O)—C(R⁵)—N(R³)— tobe a GI enzyme-cleavable moiety, such as a trypsin-cleavable moiety.

In certain instances, R⁵ is a side chain of an amino acid selected fromarginine, lysine, homoarginine, homolysine, ornithine, arginine mimic,arginine homologue, arginine truncate, arginine with varying oxidationstates, lysine mimic, lysine homologue, lysine truncate, and lysine withvarying oxidation states. In certain instances, R⁵ is a side chain of anamino acid selected from arginine, lysine, homoarginine, homolysine, andornithine. In certain instances, R⁵ is a side chain of an amino acidselected from arginine or lysine. In certain instances, R⁵ is a sidechain of arginine. In certain instances, R⁵ is a side chain of lysine.

In certain instances, R⁵ is a side chain of an L-amino acid selectedfrom L-arginine, L-lysine, L-homoarginine, L-homolysine, L-ornithine,L-arginine mimic, L-arginine homologue, L-arginine truncate, L-argininewith varying oxidation states, L-lysine mimic, L-lysine homologue,L-lysine truncate, and L-lysine with varying oxidation states. Incertain instances, R⁵ is a side chain of an L-amino acid selected fromL-arginine, L-lysine, L-homoarginine, L-homolysine, and L-ornithine. Incertain instances, R⁵ is a side chain of an L-amino acid selected fromL-arginine and L-lysine. In certain instances, R⁵ is a side chain ofL-arginine. In certain instances, R⁵ is a side chain of L-lysine.

In certain instances, R⁵

represents —CH₂CH₂CH₂NH(C(═NH)(NH₂)) or —CH₂CH₂CH₂CH₂NH₂, theconfiguration of the carbon atom to which R⁵ is attached correspondingwith that in an L-amino acid.

In formulae I-XV, b is a number from zero to 100. In certain instances,b is zero to 50. In certain instances, b is zero to 90, 80, 70, 60, 50,40, 30, 20, or 10. In certain instances, b is 100. In certain instances,b is 75. In certain instances, b is 50. In certain instances, b is 25.In certain instances, b is 20. In certain instances, b is 15. In certaininstances, b is 10. In certain instances, b is 9. In certain instances,b is 8. In certain instances, b is 7. In certain instances, b is 6. Incertain instances, b is 5. In certain instances, b is 4. In certaininstances, b is 3. In certain instances, b is 2. In certain instances, bis one. In certain instances, b is zero. In certain instances, b is zeroor one. In certain instances, b is zero or one or two.

In formulae I-III, VI-VII, X, and XIII, each R⁶ can be independentlyselected from hydrogen, alkyl, substituted alkyl, aryl, substitutedaryl, arylalkyl, substituted arylalkyl, heteroalkyl, substitutedheteroalkyl, heteroaryl, substituted heteroaryl, heteroarylalkyl, andsubstituted heteroarylalkyl.

In certain instances, formulae I-III, VI-VII, X, and XIII, each R⁶ isindependently selected from hydrogen, alkyl, substituted alkyl, aryl,substituted aryl, arylalkyl, substituted arylalkyl, heteroalkyl,substituted heteroalkyl, heteroaryl, substituted heteroaryl,heteroarylalkyl, and substituted heteroarylalkyl. In certain instances,R⁶ is hydrogen. In certain instances, R⁶ is alkyl. In certain instances,R⁶ is substituted alkyl. In certain instances, R⁶ is arylalkyl orsubstituted arylalkyl. In certain instances, R⁶ is heteroarylalkyl orsubstituted heteroarylalkyl.

In certain instances, formulae I-III, VI-VII, X, and XIII, R⁶ is a sidechain of an amino acid, a side chain of an amino acid variant, aderivative of a side chain of an amino acid, or a derivative of a sidechain of an amino acid variant. In certain instances, R⁶ is a side chainof an amino acid. In certain instances, R⁶ is a side chain of an aminoacid variant. In certain instances, R⁶ is a derivative of a side chainof an amino acid. In certain instances, R⁶ is a derivative of a sidechain of an amino acid variant.

In formulae IV, V, VIII, IX, XI, XII, XIV, and XV each R⁶ is a sidechain of an amino acid independently selected from alanine, arginine,asparagine, aspartic acid, cysteine, glutamic acid, glutamine, glycine,histidine, isoleucine, leucine, lysine, methionine, phenylalanine,proline, serine, threonine, tryptophan, tyrosine and valine.

In certain instances, R⁶ is a side chain of an L-amino acid selectedfrom L-alanine, L-arginine, L-asparagine, L-aspartic acid, L-cysteine,L-glutamic acid, L-glutamine, glycine, L-histidine, L-isoleucine,L-leucine, L-lysine, L-methionine, L-phenylalanine, L-proline, L-serine,L-threonine, L-tryptophan, L-tyrosine, and L-valine.

In certain instances, R⁶ that is immediately adjacent to R⁵ represents—H or —CH₃, the configuration of the carbon atom to which R⁶ is attachedcorresponding with that in an L-amino acid. In certain instances, R⁶that is immediately adjacent to R⁵ represents —H. In certain instances,R⁶ that is immediately adjacent to R⁵ represents —CH₃, the configurationof the carbon atom to which R⁶ is attached corresponding with that in anL-amino acid.

In certain instances, R⁶ that is immediately adjacent to R⁵ is a sidechain of an amino acid selected from L-alanine and glycine. In certaininstances, R⁶ that is immediately adjacent to R⁵ is a side chain ofL-alanine. In certain instances, R⁶ that is immediately adjacent to R⁵is a side chain of glycine.

In formulae I-XV, R⁷ can be selected from hydrogen, alkyl, substitutedalkyl, acyl, substituted acyl, alkoxycarbonyl, substitutedalkoxycarbonyl, aryl, substituted aryl, arylalkyl, and substitutedarylalkyl.

In certain instances, R⁷ is hydrogen, alkyl, acyl, or substituted acyl.In certain instances, R⁷ is hydrogen, acyl, or substituted acyl. Incertain instances, R⁷ is hydrogen. In certain instances, R⁷ is alkyl. Incertain instances, R⁷ is acyl or substituted acyl. In certain instances,R⁷ is acyl. In certain instances, R⁷ is substituted acyl. In certaininstances, R⁷ can be acetyl, benzoyl, malonyl, piperonyl or succinyl. Incertain instances, R⁷ can be acetyl. In certain instances, R⁷ can bemalonyl.

In certain instances, a certain group of compounds are compounds offormulae I-XV, wherein R⁵ is a side chain of an amino acid selected fromarginine and lysine and b is one. In certain instances, a certain groupof compounds are compounds of formulae I-XV, wherein R⁵ is a side chainof an amino acid selected from arginine and lysine; R⁶ is a side chainof an amino acid selected from alanine and glycine; and b is one. Incertain instances, a certain group of compounds are compounds offormulae I-XV, wherein R⁵ is a side chain of an amino acid selected fromL-arginine and L-lysine and b is one. In certain instances, a certaingroup of compounds are compounds of formulae I-XV, wherein R⁵ is a sidechain of an amino acid selected from L-arginine and L-lysine; R⁶ is aside chain of an amino acid selected from L-alanine and glycine; and bis one. In certain instances, a certain group of compounds are compoundsof formulae I-XV, wherein R⁵ is a side chain of L-arginine; R⁶ is a sidechain of an amino acid selected from L-alanine and glycine; and b isone. In certain instances, a certain group of compounds are compounds offormulae I-XV, wherein R⁵ is a side chain of L-lysine; R⁶ is a sidechain of an amino acid selected from L-alanine and glycine; and b isone.

In certain instances, a certain group of compounds are compounds offormulae I-XV, wherein R⁶ is a side chain of glycine and b is one. Incertain instances, a certain group of compounds are compounds offormulae I-XV, wherein R⁵ is a side chain of an amino acid selected fromarginine and lysine; R⁶ is a side chain of glycine; and b is one. Incertain instances, a certain group of compounds are compounds offormulae I-XV, wherein R⁵ is a side chain of an amino acid selected fromL-arginine and L-lysine; R⁶ is a side chain of glycine; and b is one.

In certain instances, a certain group of compounds are compounds offormulae I-XV, wherein R⁶ is a side chain of alanine and b is one. Incertain instances, a certain group of compounds are compounds offormulae I-XV, wherein R⁶ is a side chain of L-alanine and b is one. Incertain instances, a certain group of compounds are compounds offormulae I-XV, wherein R⁵ is a side chain of an amino acid selected fromarginine and lysine; R⁶ is a side chain of alanine; and b is one. Incertain instances, a certain group of compounds are compounds offormulae I-XV, wherein R⁵ is a side chain of an amino acid selected fromL-arginine and L-lysine; R⁶ is a side chain of L-alanine; and b is one.

In certain instances, a certain group of compounds are compounds offormulae I-XV, wherein R⁵ is a side chain of L-arginine; R⁶ is a sidechain of L-alanine; and b is one. In certain instances, a certain groupof compounds are compounds of formulae I-XV, wherein R⁵ is a side chainof L-arginine; R⁶ is a side chain of glycine; and b is one. In certaininstances, a certain group of compounds are compounds of formulae I-XV,wherein R⁵ is a side chain of L-lysine; R⁶ is a side chain of L-alanine;and b is one. In certain instances, a certain group of compounds arecompounds of formulae I-XV, wherein R⁵ is a side chain of L-lysine; R⁶is a side chain of glycine; and b is one.

Amino Acids Found in Prodrugs

“Amino acid” means a building block of a polypeptide. As used herein,“amino acid” includes the 20 common naturally occurring L-amino acidsand all amino acids variants. In certain embodiments, an amino acid is acleavable substrate for a gastrointestinal enzyme.

“Naturally occurring amino acids” means the 20 common naturallyoccurring L-amino acids, that is, alanine, arginine, asparagine,aspartic acid, cysteine, glutamic acid, glutamine, glycine, histidine,isoleucine, leucine, lysine, methionine, phenylalanine, proline, serine,threonine, tryptophan, tyrosine and valine.

“Amino acid variants” means an amino acid other than any of the 20common naturally occurring L-amino acids that is hydrolyzable by aprotease in a manner similar to the ability of a protease to hydrolyze anaturally occurring L-amino acid. Amino acid variants, thus, includeamino acids or analogs of amino acids other than the 20naturally-occurring amino acids. Amino acid variants include syntheticamino acids.

The embodiments also include derivatives of amino acids and of aminoacid variants. A derivative of an amino acid or of an amino acid variantrefers to a substance that has been altered from another substance bymodification, partial substitution, homologation, truncation, or achange in oxidation state, while retaining the ability to be cleaved bya GI enzyme.

Certain examples of amino acid variants include, but are not limited to:2-aminoindane-2-carboxylic acid, 2-aminoisobutyric acid,4-amino-phenylalanine, 5-hydroxylysine, biphenylalanine, citrulline,cyclohexylalanine, cyclohexylglycine, diethylglycine, dipropylglycine,homoarginine, homocitrulline, homophenylalanine, homoproline,homoserine, homotyrosine, hydroxyproline, lanthionine, naphthylalanine,norleucine, ornithine, phenylalanine(4-fluoro), phenylalanine(4-nitro),phenylglycine, pipecolic acid, tert-butylalanine, tert-butylglycine,tert-leucine, tetrahydroisoquinoline-3-carboxylic acid, α-aminobutyricacid, γ-amino butyric acid, 2,3-diaminoproprionic acid,phenylalanine(2,3,4,5,6 pentafluoro), aminohexanoic acid and derivativesthereof.

Certain examples of amino acid variants include, but are not limited to,N-methyl amino acids. For example, N-methyl-alanine, N-methyl asparticacid, N-methyl-glutamic acid, N-methyl-glycine (sarcosine) are N-methylamino acids.

Certain examples of amino acid variants include, but are not limited to:dehydroalanine, ethionine, hypusine, lanthionine, pyrrolysine,α-aminoisobutyric acid, selenomethionine and derivatives thereof.

Certain examples of amino acid variants include, but are not limited to:(3,2-amino benzoic acid, 2-amino methyl benzoic acid,2-amino-3-guanidinopropionic acid, 2-amino-3-methoxy benzoic acid,2-amino-3-ureidopropionic acid, 3-amino benzoic acid, 4-amino benzoicacid, 4-amino methyl benzoic acid, 4-nitroanthranillic acid,5-acetamido-2-aminobenzoic acid, butanoic acid (HMB), glutathione,homocysteine, statine, taurine, β-alanine, 2-hydroxy-4-(methylthio),(3,4)-diamino benzoic acid, (3,5)-diamino benzoic acid and derivativesthereof.

Certain examples of amino acid variants include, but are not limited to:(2 amino ethyl) cysteine, 2-amino-3-ethyoxybutanoic acid, buthionine,cystathion, cysteic acid, ethionine, ethoxytheorine, methylserine,N-ε-ε-dimethyl-lysine, N-ω-nitro-arginine, saccharopine, isoserinederivatives thereof, and combinations thereof.

Certain examples of amino acid variants include, but are not limited to:l-carnitine, selenocysteine, l-sarcosine, l-lysinol, benzoic acid,citric acid, choline, EDTA or succinic acid and derivatives thereof.

Certain examples of amino acid variants are amino alcohols. Examples ofamino alcohols include, but are not limited to: alaminol, indano,norephedrine, asparaginol, aspartimol, glutamol, leucinol, methioninol,phenylalaminol, prolinol, tryptophanol, valinol, isoleucinol, argininol,serinol, tyrosinol, threoninol, cysteinol, lysinol, histidinol andderivatives thereof.

General Synthetic Procedures for Formulae I-XV

Representative synthetic schemes for compounds disclosed herein areshown below. Compounds of Formulae I-XV can be synthesized by using thedisclosed methods.

Representative Synthetic Schemes

A representative synthesis for Compound S-104 is shown in Scheme 1. InScheme 1, R^(a), A ring, Y, and c are defined herein. PG¹ is an aminoprotecting group. Although the schemes herein show a morphinan structurefor X in Formulae I-XV, the entire scope of X as an opioid as applicableto Formula I-XV is contemplated. Also, although the schemes herein showR¹ and R² as being hydrogen and a being one, the entire scope of R¹, R²,and a as applicable to Formula I-XV is contemplated.

In Scheme 1, Compound S-100 is a commercially available startingmaterial. Alternatively, Compound S-100 can be semi-syntheticallyderived from natural materials or synthesized via a variety of differentsynthetic routes using commercially available starting materials and/orstarting materials prepared by conventional synthetic methods.

With continued reference to Scheme 1, Compound S-100 is enolized.Enolization of a ketone can be performed with reaction with a strongbase, such as potassium hexamethyldisilazide (KHMDS). The enolate ofCompound S-100 is then reacted with an activation agent, such asCompound S-101, to form intermediate Compound S-102. Suitable activationagents include carbonate-forming reagents, such as chloroformates. InScheme 1, the activation agent Compound S-101 is 4-nitrophenylchloroformate. Other suitable activation agents can be used prior toreaction with Compound S-103.

With continued reference to Scheme 1, Compound S-102 reacts withCompound S-103 to form Compound S-104. In Scheme 1, Compound S-103 is acommercially available starting material. Alternatively, Compound S-103can be synthesized via a variety of different synthetic routes usingcommercially available starting materials and/or starting materialsprepared by conventional synthetic methods.

A representative synthesis for Compound S-203 is shown in Scheme 2. InScheme 2, R^(a), A ring, Y, c, and R⁵ are defined herein. PG¹ and PG²are amino protecting groups.

In Scheme 2, the protecting group PG¹ is removed from Compound S-104 toform Compound S-201. Conditions to remove amino groups can be found inGreene and Wuts. When PG¹ is a Boc group, the protecting group can beremoved with acidic conditions, such as treatment with hydrochloric acidor trifluoroacetic acid.

With reference to Scheme 2, Compound S-201 reacts with Compound S-202 toform Compound S-203 in a peptide coupling reaction. In certainembodiments, R⁵ is a side chain of an amino acid and is optionallyprotected. Protecting groups for the side chain of amino acids are knownto those skilled in art and can be found in Greene and Wuts. In certaininstances, the protecting group for the side chain of arginine is asulfonyl-type protecting group, such as2,2,4,6,7-pentamethyldihydrobenzofurane (Pbf). Other protecting groupsinclude 2,2,5,7,8-pentamethylchroman (Pmc) and1,2-dimethylindole-3-sulfonyl (MIS).

A peptide coupling reaction typically employs a conventional peptidecoupling reagent and is conducted under conventional coupling reactionconditions, typically in the presence of a trialkylamine, such astriethylamine or diisopropylethylamine (DIEA). Suitable couplingreagents for use include, by way of example, carbodiimides, such asethyl-3-(3-dimethylamino)propylcarbodiimide (EDC),dicyclohexylcarbodiimide (DCC), diisopropylcarbodiimide (DIC) and thelike, and other well-known coupling reagents, such asN,N′-carbonyldiimidazole, 2-ethoxy-1-ethoxycarbonyl-1,2-dihydroquinoline(EEDQ), benzotriazol-1-yloxy-tris(dimethylamino)phosphoniumhexafluorophosphate (BOP),O-(7-azabenzotriazol-1-yl)-N,N,N,N′,N′-tetramethyluroniumhexafluorophosphate (HATU) and the like. Optionally, well-known couplingpromoters, such as N-hydroxysuccinimide, 1-hydroxybenzotriazole (HOBT),1-hydroxy-7-azabenzotriazole (HOAT), N,N-dimethylaminopyridine (DMAP)and the like, can be employed in this reaction. Typically, this couplingreaction is conducted at a temperature ranging from about 0° C. to about60° C. for about 1 to about 72 hours in an inert diluent, such as THF orDMF. In certain instances, Compound S-201 reacts with Compound S-202 toform Compound S-203 in the presence of HATU.

A representative synthesis for Compound S-303 is shown in Scheme 3. InScheme 3, R^(a), A ring, Y, c, R⁵, R⁶, and R⁷ are defined herein. PG² isan amino protecting group.

In Scheme 3, the protecting group PG² is removed from Compound S-203 toform Compound S-301. Conditions to remove amino groups can be found inGreene and Wuts. When PG² is a Boc group, the protecting group can beremoved with acidic conditions, such as treatment with hydrochloric acidor trifluoroacetic acid.

With reference to Scheme 3, Compound S-301 reacts with Compound S-302 toform Compound S-303 in a peptide coupling reaction. A peptide couplingreaction typically employs a conventional peptide coupling reagent andis conducted under conventional coupling reaction conditions, typicallyin the presence of a trialkylamine, such as triethylamine ordiisopropylethylamine (DIEA). Suitable coupling reagents for useinclude, by way of example, carbodiimides, such asethyl-3-(3-dimethylamino)propylcarbodiimide (EDC),dicyclohexylcarbodiimide (DCC), diisopropylcarbodiimide (DIC) and thelike, and other well-known coupling reagents, such asN,N′-carbonyldiimidazole, 2-ethoxy-1-ethoxycarbonyl-1,2-dihydroquinoline(EEDQ), benzotriazol-1-yloxy-tris(dimethylamino)phosphoniumhexafluorophosphate (BOP),O-(7-azabenzotriazol-1-yl)-N,N,N,N′,N′-tetramethyluroniumhexafluorophosphate (HATU) and the like. Optionally, well-known couplingpromoters, such as N-hydroxysuccinimide, 1-hydroxybenzotriazole (HOBT),1-hydroxy-7-azabenzotriazole (HOAT), N,N-dimethylaminopyridine (DMAP)and the like, can be employed in this reaction. Typically, this couplingreaction is conducted at a temperature ranging from about 0° C. to about60° C. for about 1 to about 72 hours in an inert diluent, such as THF orDMF. In certain instances, Compound S-301 reacts with Compound S-302 toform Compound S-303 in the presence of HATU.

In certain instances in Scheme 3, Compound S-301 is reacted withCompound S-302 with R⁷ as a protecting group for an amino group. Inthese instances, the protecting group can be removed and the R⁷ group asan N-derivative group can be attached. Conditions for removal of otherprotecting groups depend on the identity of the protecting group and areknown to those skilled in the art. The conditions can also be found inGreene and Wuts. For example, a malonyl group can be attached via areaction with mono-tert-butyl malonate. Reaction using mono-tert-butylmalonate can be aided with use of activation reagents, such as symmetricanhydrides, O-(benzotriazol-1-yl)-N,N,N′,N′-tetramethyluroniumhexafluorophosphate (HBTU), dicyclohexylcarbodiimide (DCC)diisopropylcarbodiimide (DIC)/1-hydroxybenzotriazole (HOBt), andbenzotriazole-1-yl-oxytris(dimethylamino)phosphonium hexafluorophosphate(BOP). In another example, an alkanoyl group, such as an acetyl group,can be attached via a reaction with alkanoyl anhydride or alkanoylhalide.

Additional amino acids can be added to the compound through standardpeptide coupling reactions as discussed herein. Removal of otherprotecting groups can be performed if other protecting groups were used,such as protecting groups present on the R⁵ or R⁶ moiety. Conditions forremoval of other protecting groups depend on the identity of theprotecting group and are known to those skilled in the art. Theconditions can also be found in Greene and Wuts.

Additional Representative Synthetic Schemes

Representative synthesis for Compound S-404 is shown in Scheme 4. InScheme 4, A ring, Y, c, and R⁵ are defined herein. PG¹ and PG² are aminoprotecting groups. Although the schemes herein show R¹ and R² as beinghydrogen and a being one, the entire scope of R¹, R², and a asapplicable to Formula I-XV is contemplated.

In Scheme 4, Compound S-401 is a commercially available startingmaterial. Alternatively, Compound S-401 can be semi-syntheticallyderived from natural materials or synthesized via a variety of differentsynthetic routes using commercially available starting materials and/orstarting materials prepared by conventional synthetic methods. Withcontinued reference to Scheme 4, the protecting group PG¹ is removedfrom Compound S-401 to form Compound S-402. Conditions to remove aminogroups can be found in Greene and Wuts. When PG¹ is a Boc group, theprotecting group can be removed with acidic conditions, such astreatment with hydrochloric acid or trifluoroacetic acid.

With continued reference to Scheme 4, Compound S-402 reacts withCompound S-403 to form Compound S-404 in a peptide coupling reaction. Incertain embodiments, R⁵ is a side chain of an amino acid and isoptionally protected. Protecting groups for the side chain of aminoacids are known to those skilled in art and can be found in Greene andWuts. In certain instances, the protecting group for the side chain ofarginine is a sulfonyl-type protecting group, such as2,2,4,6,7-pentamethyldihydrobenzofurane (Pbf). Other protecting groupsinclude 2,2,5,7,8-pentamethylchroman (Pmc) and1,2-dimethylindole-3-sulfonyl (MIS).

A peptide coupling reaction typically employs a conventional peptidecoupling reagent and is conducted under conventional coupling reactionconditions, typically in the presence of a trialkylamine, such astriethylamine or diisopropylethylamine (DIEA). Suitable couplingreagents for use include, by way of example, carbodiimides, such asethyl-3-(3-dimethylamino)propylcarbodiimide (EDC),dicyclohexylcarbodiimide (DCC), diisopropylcarbodiimide (DIC) and thelike, and other well-known coupling reagents, such asN,N′-carbonyldiimidazole, 2-ethoxy-1-ethoxycarbonyl-1,2-dihydroquinoline(EEDQ), benzotriazol-1-yloxy-tris(dimethylamino)phosphoniumhexafluorophosphate (BOP),O-(7-azabenzotriazol-1-yl)-N,N,N,N′,N′-tetramethyluroniumhexafluorophosphate (HATU) and the like. Optionally, well-known couplingpromoters, such as N-hydroxysuccinimide, 1-hydroxybenzotriazole (HOBT),1-hydroxy-7-azabenzotriazole (HOAT), N,N-dimethylaminopyridine (DMAP)and the like, can be employed in this reaction. Typically, this couplingreaction is conducted at a temperature ranging from about 0° C. to about60° C. for about 1 to about 72 hours in an inert diluent, such as THF orDMF. In certain instances, Compound S-402 reacts with Compound S-403 toform Compound S-404 in the presence of HATU.

A representative synthesis for Compound S-503 is shown in Scheme 5. InScheme 5, A ring, Y, c, and R⁵ are defined herein. PG² is an aminoprotecting group.

In Scheme 5, Compound S-501 is reacted with an activation agent, such asCompound S-502. Suitable activation agents include carbonate-formingreagents, such as chloroformates. In Scheme 5, the activation agentCompound S-502 is 4-nitrophenyl chloroformate. Other suitable activationagents can be used prior to reaction with Compound S-404.

With continued reference to Scheme 5, activated Compound S-501 reactswith Compound S-404 to form Compound S-503. In Scheme 5, Compound S-501is a commercially available starting material. Alternatively, CompoundS-501 can be synthesized via a variety of different synthetic routesusing commercially available starting materials and/or startingmaterials prepared by conventional synthetic methods.

Additional amino acids can be added to the compound through standardpeptide coupling reactions as discussed herein. For example, additionalamino acids can be added to Compound S-503 with removal of protectinggroup PG² and addition of amino acids through standard peptide couplingreactions. Additional amino acids can be also added to Compound S-404before reaction with Compound S-501 with removal of protecting group PG²and addition of amino acids through standard peptide coupling reactions.

In Scheme 6, Compound S-503 is converted to Compound S-601 with R⁷ as anN-derivative group. Conditions for removal of protecting groups dependon the identity of the protecting group and are known to those skilledin the art. The conditions can also be found in Greene and Wuts. Incertain instances, for example, a malonyl group can be attached via areaction with mono-tert-butyl malonate. Reaction using mono-tert-butylmalonate can be aided with use of activation reagents, such as symmetricanhydrides, O-(benzotriazol-1-yl)-N,N,N′,N′-tetramethyluroniumhexafluorophosphate (HBTU), dicyclohexylcarbodiimide (DCC)diisopropylcarbodiimide (DIC)/1-hydroxybenzotriazole (HOBt), andbenzotriazole-1-yl-oxytris(dimethylamino)phosphonium hexafluorophosphate(BOP). In another example, an alkanoyl group, such as an acetyl group,can be attached via a reaction with alkanoyl anhydride or alkanoylhalide.

Removal of other protecting groups can be performed if other protectinggroups were used, such as protecting groups present on the R⁵ or R⁶moiety. Conditions for removal of other protecting groups depend on theidentity of the protecting group and are known to those skilled in theart. The conditions can also be found in Greene and Wuts.

Enzyme Inhibitors

The enzyme capable of cleaving the enzyme-cleavable moiety of an opioidprodrug can be a peptidase, also called a protease. In certainembodiments, the enzyme is an enzyme located in the gastrointestinal(GI) tract, i.e., a gastrointestinal enzyme, or a GI enzyme. The enzymecan be a digestive enzyme such as a gastric, intestinal, pancreatic orbrush border enzyme or enzyme of GI microbial flora, such as thoseinvolved in peptide hydrolysis. Examples include a pepsin, such aspepsin A or pepsin B; a trypsin; a chymotrypsin; an elastase; acarboxypeptidase, such as carboxypeptidase A or carboxypeptidase B; anaminopeptidase (such as aminopeptidase N or aminopeptidase A; anendopeptidase; an exopeptidase; a dipeptidylaminopeptidase such asdipeptidylaminopeptidase IV; a dipeptidase; a tripeptidase; or anenteropeptidase. In certain embodiments, the enzyme is a cytoplasmicprotease located on or in the GI brush border. In certain embodiments,the enzyme is trypsin. Accordingly, in certain embodiments, thecorresponding composition is administered orally to the patient.

The disclosure provides for a composition comprising a GI enzymeinhibitor. Such an inhibitor can inhibit at least one of any of the GIenzymes disclosed herein. An example of a GI enzyme inhibitor is aprotease inhibitor, such as a trypsin inhibitor.

As used herein, the term “GI enzyme inhibitor” refers to any agentcapable of inhibiting the action of a GI enzyme on a substrate. Theability of an agent to inhibit a GI enzyme can be measured using assayswell known in the art.

In certain embodiments, the GI enzyme capable of cleaving theenzyme-cleavable moiety may be a protease. The disclosure provides forinhibitors of proteases.

Proteases can be classified as exopeptidases or endopeptidases. Examplesof exopeptidases include aminopeptidase and carboxypeptidase (A, B, orY). Examples of endopeptidases include trypsin, chymotrypsin, elastase,pepsin, and papain. The disclosure provides for inhibitors ofexopeptidase and endopeptidase.

In some embodiments, the enzyme is a digestive enzyme of a protein. Thedisclosure provides for inhibitors of digestive enzymes. A gastric phaseinvolves stomach enzymes, such as pepsin. An intestinal phase involvesenzymes in the small intestine duodenum, such as trypsin, chymotrypsin,elastase, carboxypeptidase A, and carboxypeptidase B. An intestinalbrush border phase involves enzymes in the small intestinal brushborder, such as aminopeptidase N, aminopeptidase A, endopeptidases,dipeptidases, dipeptidylaminopeptidase, and dipeptidylaminopeptidase IV.An intestinal intracellular phase involves intracellular peptidases,such as dipeptidases (i.e. iminopeptidase) and aminopeptidase.

In certain embodiments, the enzyme inhibitor in the disclosedcompositions is a peptidase inhibitor or protease inhibitor. In certainembodiments, the enzyme is a digestive enzyme such as a gastric,pancreatic or brush border enzyme, such as those involved in peptidehydrolysis. Examples include pepsin, trypsin, chymotrypsin, colipase,elastase, aminopeptidase N, aminopeptidase A, dipeptidylaminopeptidaseIV, tripeptidase or enteropeptidase.

Proteases can be inhibited by naturally occurring peptide or proteininhibitors, or by small molecule naturally occurring or syntheticinhibitors. Examples of protein or peptide inhibitors that are proteaseinhibitors include, but are not limited to, α1-antitrypsin from humanplasma, aprotinin, trypsin inhibitor from soybean (SBTI), Bowman-BirkInhibitor from soybean (BBSI), trypsin inhibitor from egg white(ovomucoid), chromostatin, and potato-derived carboxypeptidaseinhibitor. Examples of small molecule irreversible inhibitors that areprotease inhibitors include, but are not limited to, TPCK(1-chloro-3-tosylamido-4-phenyl-2-butanone), TLCK(1-chloro-3-tosylamido-7-amino-2-heptone), and PMSF (phenylmethylsulfonyl fluoride). Examples of small molecule irreversible inhibitorsthat are protease inhibitors include, but are not limited tobenzamidine, apixaban, camostat, 3,4-dichloroisocoumarin,ε-aminocaprionic acid, amastatin, lysianadioic acid,1,10-phenanthroline, cysteamine, and bestatin. Other examples of smallmolecule inhibitors are Compound 101, Compound 102, Compound 103,Compound 104, Compound 105, Compound 106, Compound 107, Compound 108,Compound 109 and Compound 110.

The following table shows examples of gastrointestinal (GI) proteases,examples of their corresponding substrates, and examples ofcorresponding inhibitors.

Table of Examples of GI Proteases and Corresponding Substrates andInhibitors GI Protease Substrates Inhibitors Trypsin Arg, Lys, TLCK,Benzamidine, positively Apixaban, Bowman Birk charged residuesChymotrypsin Phe, Tyr, Trp, ε-Aminocaprionic bulky TPCK hydrophobicBowman-Birk residues Pepsin Leu, Phe, Trp, Pepstatin, PMSF TyrCarboxypeptidase B Arg, Lys Potato-derived inhibitor, Lysianadioic acidCarboxypeptidase A not Arg, Lys Potato-derived inhibitor, 1,10-phenanthroline Elastase Ala, Gly, Ser, α1-antitrypsin, 3,4-dichloro-small neutral coumarin residues Aminopeptidase All free N- Bestatin,Amastatin terminal AATrypsin Inhibitors

As used herein, the term “trypsin inhibitor” refers to any agent capableof inhibiting the action of trypsin on a substrate. The term “trypsininhibitor” also encompasses salts of trypsin inhibitors. The ability ofan agent to inhibit trypsin can be measured using assays well known inthe art. For example, in a typical a typical assay, one unit correspondsto the amount of inhibitor that reduces the trypsin activity by onebenzoyl-L-arginine ethyl ester unit (BAEE-U). One BAEE-U is the amountof enzyme that increases the absorbance eeeeat 253 nm by 0.001 perminute at pH 7.6 and 25° C. See, for example, K. Ozawa, M. Laskowski,1966, J. Biol. Chem. 241, 3955 and Y. Birk, 1976, Meth. Enzymol. 45,700. In certain instances, a trypsin inhibitor can interact with anactive site of trypsin, such as the S1 pocket and the S3/4 pocket. TheS1 pocket has an aspartate residue which has affinity for positivelycharged moiety. The S3/4 pocket is a hydrophobic pocket. The disclosureprovides for specific trypsin inhibitors and non-specific serineprotease inhibitors.

There are many trypsin inhibitors known in the art, both those specificto trypsin and those that inhibit trypsin and other proteases such aschymotrypsin. The disclosure provides for trypsin inhibitors that areproteins, peptides, and small molecules. The disclosure provides fortrypsin inhibitors that are irreversible inhibitors or reversibleinhibitors. The disclosure provides for trypsin inhibitors that arecompetitive inhibitors, non-competitive inhibitors, or uncompetitiveinhibitors. The disclosure provides for natural, synthetic orsemi-synthetic trypsin inhibitors.

Trypsin inhibitors can be derived from a variety of animal or vegetablesources: for example, soybean, corn, lima and other beans, squash,sunflower, bovine and other animal pancreas and lung, chicken and turkeyegg white, soy-based infant formula, and mammalian blood. Trypsininhibitors can also be of microbial origin: for example, antipain; see,for example, H. Umezawa, 1976, Meth. Enzymol. 45, 678.

In one embodiment, the trypsin inhibitor is derived from soybean.Trypsin inhibitors derived from soybean (Glycine max) are readilyavailable and are considered to be safe for human consumption. Theyinclude, but are not limited to, SBTI, which inhibits trypsin, andBowman-Birk inhibitor, which inhibits trypsin and chymotrypsin. Suchtrypsin inhibitors are available, for example from Sigma-Aldrich, St.Louis, Mo., USA.

A trypsin inhibitor can be an arginine mimic or lysine mimic, eithernatural or synthetic compound. In certain embodiments, the trypsininhibitor is an arginine mimic or a lysine mimic, wherein the argininemimic or lysine mimic is a synthetic compound. As used herein, anarginine mimic or lysine mimic can include a compound capable of bindingto the P¹ pocket of trypsin and/or interfering with trypsin active sitefunction. The arginine or lysine mimic can be a cleavable ornon-cleavable moiety.

Examples of trypsin inhibitors, which are arginine mimics and/or lysinemimics, include, but not limited to, arylguanidine, benzamidine,3,4-dichloroisocoumarin, diisopropylfluorophosphate, gabexate mesylate,and phenylmethanesulfonyl fluoride, or substituted versions or analogsthereof. In certain embodiments, trypsin inhibitors comprise acovalently modifiable group, such as a chloroketone moiety, an aldehydemoiety, or an epoxide moiety. Other examples of trypsin inhibitors areaprotinin, camostat and pentamidine.

Other examples of trypsin inhibitors include compounds of formula:

wherein:

Q¹ is selected from —O-Q⁴ or -Q⁴-COOH, where Q⁴ is C₁-C₄ alkyl;

Q² is N or CH; and

Q³ is aryl or substituted aryl.

Certain trypsin inhibitors include compounds of formula:

wherein:

Q⁵ is —C(O)—COOH or —NH-Q⁶-Q⁷-SO₂—C₆Hs, where

Q⁶ is —(CH₂)_(p)—COOH;

Q⁷ is —(CH₂)_(r)—C₆H₅;

Q⁸ is NH;

n is a number from zero to two;

o is zero or one;

p is an integer from one to three; and

r is an integer from one to three.

Other examples of trypsin inhibitors include compounds of formula:

wherein:

Q⁵ is —C(O)—COOH or —NH-Q⁶-Q⁷-SO₂—C₆Hs, where

Q⁶ is —(CH₂)_(p)—COOH;

Q⁷ is —(CH₂)_(r)—C₆H₅; and

p is an integer from one to three; and

r is an integer from one to three.

Certain trypsin inhibitors include the following:

Compound 101

(S)-ethyl 4-(5-guanidino- 2-(naphthalene-2- sulfonamido)pentanoyl)piperazine-1-carboxylate Compound 102

(S)-ethyl 4-(5-guanidino-2- (2,4,6-triisopropylphenyl-sulfonamido)pentanoyl) piperazine-1-carboxylate Compound 103

(S)-ethyl 1-(5-guanidino- 2-(naphthalene-2- sulfonamido)pentanoyl)piperidine-4-carboxylate Compound 104

(S)-ethyl 1-(5-guanidino-2- (2,4,6-triisopropylphenyl-sulfonamido)pentanoyl) piperidine-4-carboxylate Compound 105

(S)-6-(4-(5-guanidino- 2-(naphthalene-2- sulfonamido)pentanoyl)piperazin-1-yl)-6- oxohexanoic acid Compound 106

4-aminobenzimidamide (also 4- aminobenzamidine) Compound 107

3-(4-carbamimidoyl- phenyl)-2- oxopropanoic acid Compound 108

(S)-5-(4- carbamimidoyl- benzylamino)-5- oxo-4-((R)-4-phenyl-2-(phenylmethyl- sulfonamido)butanamido) pentanoic acid Compound 109

6-carbamimidoyl- naphthalen-2-yl 4- (diaminomethyl- eneamino)benzoateCompound 110

4,4′-(pentane-1,5- diylbis(oxy)) dibenzimidamide

A description of methods to prepare Compound 101, Compound 102, Compound103, Compound 104, Compound 105, Compound 107, and Compound 108 isprovided in PCT International Publication Number WO 2010/045599A1,published 22 Apr. 2010, which is hereby incorporated by reference in itsentirety. Compound 106, Compound 109, and Compound 110 can be obtainedcommercially (Sigma-Aldrich, St. Louis, Mo., USA.).

In certain embodiments, the trypsin inhibitor is SBTI, BBSI, Compound101, Compound 106, Compound 108, Compound 109, or Compound 110. Incertain embodiments, the trypsin inhibitor is camostat.

In certain embodiments, the trypsin inhibitor is a compound of formulaT-I:

wherein

A represents a group of the following formula:

-   -   R^(t9) and R^(t10) each represents independently a hydrogen atom        or a C₁₋₄ alkyl group, R^(t8) represents a group selected from        the following formulae:

wherein R^(t11), R^(t12) and R^(t13) each represents independently

(1) a hydrogen atom,

(2) a phenyl group,

(3) a C₁₋₄ alkyl group substituted by a phenyl group,

(4) a C₁₋₁₀ alkyl group,

(5) a C₁₋₁₀ alkoxyl group,

(6) a C₂₋₁₀ alkenyl group having 1 to 3 double bonds,

(7) a C₂₋₁₀ alkynyl group having 1 to 2 triple bonds,

(8) a group of formula: R^(t15)—C(O)XR^(t16),

-   -   wherein R^(t15) represents a single bond or a C₁₋₈ alkylene        group,    -   X represents an oxygen atom or an NH-group, and    -   R^(t16) represents a hydrogen atom, a C₁₋₄ alkyl group, a phenyl        group or a C₁₋₄ alkyl group substituted by a phenyl group, or

(9) a C₃₋₇ cycloalkyl group;

the structure

represents a 4-7 membered monocyclic hetero-ring containing 1 to 2nitrogen or oxygen atoms,

R^(t14) represents a hydrogen atom, a C₁₋₄ alkyl group substituted by aphenyl group or a group of formula: COOR^(t17), wherein R^(t17)represents a hydrogen atom, a C₁₋₄ alkyl group or a C₁₋₄ alkyl groupsubstituted by a phenyl group;

provided that R^(t11), R^(t12) and R^(t13) do not representsimultaneously hydrogen atoms;

or nontoxic salts, acid addition salts or hydrates thereof.

In certain embodiments, the trypsin inhibitor is a compound selectedfrom the following:

In certain embodiments, the trypsin inhibitor is a compound of formula(T-II):

wherein

X is NH;

n is zero or one; and

R^(t1) is selected from hydrogen, halogen, nitro, alkyl, substitutedalkyl, alkoxy, carboxyl, alkoxycarbonyl, acyl, aminoacyl, guanidine,amidino, carbamide, amino, substituted amino, hydroxyl, cyano and—(CH₂)_(m)—C(O)—O—(CH₂)_(m)—C(O)—N—R^(n1)R^(n2), wherein each m isindependently zero to 2; R^(n1) and R^(n2) are independently selectedfrom hydrogen and C₁₋₄ alkyl.

In certain embodiments, in formula T-II, R^(t1) is guanidino or amidino.

In certain embodiments, in formula T-II, R^(t1) is—(CH₂)_(m)—C(O)—O—(CH₂)_(m)—C(O)—N—R^(n1)R^(n2), wherein m is one andR^(n1) and R^(n2) are methyl.

In certain embodiments, the trypsin inhibitor is a compound of formulaT-III:

wherein

X is NH;

n is zero or one;

L^(t1) is selected from —C(O)—O—; —O—C(O)—; —O—(CH₂)_(m)—O—;—OCH₂—Ar^(t2)—CH₂O—; —C(O)—NR^(t3)—; and —NR^(t3)—C(O)—;

R^(t3) is selected from hydrogen, C₁₋₆ alkyl, and substituted C₁₋₆alkyl;

Ar^(t1) and Ar^(t2) are independently a substituted or unsubstitutedaryl group;

m is a number from 1 to 3; and

R^(t2) is selected from hydrogen, halogen, nitro, alkyl, substitutedalkyl, alkoxy, carboxyl, alkoxycarbonyl, acyl, aminoacyl, guanidine,amidino, carbamide, amino, substituted amino, hydroxyl, cyano and—(CH₂)_(m)—C(O)—O—(CH₂)_(m)—C(O)—N—R^(n1)R^(n2), wherein each m isindependently zero to 2; and R^(n1) and R^(n2) are independentlyselected from hydrogen and C₁₋₄ alkyl.

In certain embodiments, in formula T-III, R^(t2) is guanidino oramidino.

In certain embodiments, in formula T-III, R^(t2) is—(CH₂)_(m)—C(O)—O—(CH₂)_(m)—C(O)—N—R^(n1)R^(n2) wherein m is one andR^(n1) and R^(n2) are methyl.

In certain embodiments, the trypsin inhibitor is a compound of formulaT-IV:

wherein

each X is NH;

each n is independently zero or one;

L^(t1) is selected from —C(O)—O—; —O—C(O)—; —O—(CH₂)_(m)—O—;—OCH₂—Ar^(t2)—CH₂O—; —C(O)—NR^(t3)—; and —NR^(t3)—C(O)—;

R^(t3) is selected from hydrogen, C₁₋₆ alkyl, and substituted C₁₋₆alkyl;

Ar^(t1) and Ar^(t2) are independently a substituted or unsubstitutedaryl group; and

m is a number from 1 to 3.

In certain embodiments, in formula T-IV, Ar^(t1) or Ar^(t2) is phenyl.

In certain embodiments, in formula T-IV, Ar^(t1) or Ar^(t2) is naphthyl.

In certain embodiments, the trypsin inhibitor is Compound 109.

In certain embodiments, the trypsin inhibitor is

In certain embodiments, the trypsin inhibitor is Compound 110 or abis-arylamidine variant thereof; see, for example, J. D. Geratz, M.C.-F. Cheng and R. R. Tidwell (1976) J. Med. Chem. 19, 634-639.

It will be appreciated that the pharmaceutical composition according tothe embodiments may further comprise one or more additional trypsininhibitors.

It is to be appreciated that the invention also includes inhibitors ofother enzymes involved in protein assimilation that can be used incombination with a prodrug disclosed herein comprising an amino acid ofalanine, arginine, asparagine, aspartic acid, cysteine, glutamic acid,glutamine, glycine, histidine, isoleucine, leucine, lysine, methionine,phenylalanine, proline, serine, threonine, tryptophan, tyrosine, orvaline or amino acid variants thereof.

Combinations of Prodrug and Trypsin Inhibitor

As disclosed above, the present disclosure also provides pharmaceuticalcompositions, and their methods of use, where the pharmaceuticalcompositions comprise an opioid prodrug, that provides controlledrelease of an opioid, and a trypsin inhibitor that interacts with thetrypsin that mediates the -controlled release of the opioid from theprodrug so as to attenuate enzymatic cleavage of the prodrug.

The embodiments provide a pharmaceutical composition, which comprises atrypsin inhibitor and a compound of general Formulae I-XII, or apharmaceutically acceptable salt thereof. The embodiments provide apharmaceutical composition, which comprises a trypsin inhibitor and acompound of general Formulae XIII-XV, or a pharmaceutically acceptablesalt thereof.

The embodiments provide a pharmaceutical composition, which comprises acompound of Formulae T-I to T-IV and a compound of general FormulaeI-XII, or a pharmaceutically acceptable salt thereof. The embodimentsprovide a pharmaceutical composition, which comprises a compound ofFormulae T-I to T-IV and a compound of general Formulae XIII-XV, or apharmaceutically acceptable salt thereof. The embodiments provide apharmaceutical composition, which comprises Compound 109 and a compoundof general Formulae I-XII, or a pharmaceutically acceptable saltthereof. The embodiments provide a pharmaceutical composition, whichcomprises Compound 109 and a compound of general Formulae XIII-XV, or apharmaceutically acceptable salt thereof.

Certain embodiments provide for a combination of a compound of Formula Iand a trypsin inhibitor, shown in the table below. Certain embodimentsprovide for a combination of a compound of Formulae II-V and a trypsininhibitor, shown in the table below. Certain embodiments provide for acombination of a compound of Formulae VI-IX and a trypsin inhibitor,shown in the table below. Certain embodiments provide for a combinationof a compound of Formulae X-XII and a trypsin inhibitor, shown in thetable below. Certain embodiments provide for a combination of a compoundof Formulae XIII-XV and a trypsin inhibitor, shown in the table below.

Prodrug of Formula Prodrug of Formula Prodrug of Formula Prodrug ofFormula Prodrug of Formula I II-V and Trypsin VI-IX and Trypsin X-XIIand Trypsin XIII-XV and Trypsin and Trypsin Inhibitor InhibitorInhibitor Inhibitor Inhibitor SBTI SBTI SBTI SBTI SBTI BBSI BBSI BBSIBBSI BBSI Compound 101 Compound 101 Compound 101 Compound 101 Compound101 Compound 106 Compound 106 Compound 106 Compound 106 Compound 106Compound 108 Compound 108 Compound 108 Compound 108 Compound 108Compound 109 Compound 109 Compound 109 Compound 109 Compound 109Compound 110 Compound 110 Compound 110 Compound 110 Compound 110Combinations of Opioid Prodrugs and Other Drugs

The disclosure provides for an opioid prodrug of the embodiments and afurther prodrug or drug included in a pharmaceutical composition. Such aprodrug or drug would provide additional analgesia, e.g., a synergisticeffect, or other benefits. Examples include opioids, opioid prodrugs,acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs) and otheranalgesics. In one embodiment, two or more opioid agonist prodrugsand/or drugs (e.g., a morphine prodrug or drug and an oxycodone prodrugof the embodiments), each at a sub-analgesic dose, would be combined toprovide a synergistic response leading to effective analgesia withreduced side effects. In one embodiment, an opioid agonist prodrug ordrug would be combined with an opioid antagonist prodrug or drug. Otherexamples include drugs or prodrugs that have benefits other than, or inaddition to, analgesia. The embodiments provide a pharmaceuticalcomposition, which comprises an opioid prodrug and acetaminophen andoptionally comprises an enzyme inhibitor. Also included arepharmaceutically acceptable salts thereof.

In certain embodiments, the enzyme inhibitor is selected from SBTI,BBSI, Compound 101, Compound 106, Compound 108, Compound 109, andCompound 110. In certain embodiments, the enzyme inhibitor is camostat.

In certain embodiments, a pharmaceutical composition can comprise anopioid prodrug, a non-opioid drug and at least one opioid or opioidprodrug.

Pharmaceutical Compositions and Methods of Use

The present disclosure provides a composition, such as a pharmaceuticalcomposition, which comprises a compound of Formulae I-XV. Such apharmaceutical composition according to the embodiments can furthercomprise a pharmaceutically acceptable carrier. The composition isconveniently formulated in a form suitable for oral (including buccaland sublingual) administration, for example as a tablet, capsule, thinfilm, powder, suspension, solution, syrup, dispersion or emulsion. Thecomposition can contain components conventional in pharmaceuticalpreparations, e.g. one or more carriers, binders, lubricants, excipients(e.g., to impart controlled release characteristics), pH modifiers,sweeteners, bulking agents, coloring agents or further active agents.

Patients can be humans, and also other mammals, such as livestock, zooanimals and companion animals, such as a cat, dog or horse.

In another aspect, the embodiments provide a pharmaceutical compositionas described herein for use in the treatment of pain. The pharmaceuticalcomposition according to the embodiments is useful, for example, in thetreatment of a patient suffering from, or at risk of suffering frompain. Accordingly, the present disclosure provides methods of treatingor preventing pain in a subject, the methods involving administering tothe subject a disclosed composition. The present disclosure provides fora disclosed composition for use in therapy or prevention or as amedicament. The present disclosure also provides the use of a disclosedcomposition for the manufacture of a medicament, especially for themanufacture of a medicament for the treatment or prevention of pain.

The compositions of the present disclosure can be used in the treatmentor prevention of pain including, but not limited to include, acute pain,chronic pain, neuropathic pain, acute traumatic pain, arthritic pain,osteoarthritic pain, rheumatoid arthritic pain, muscular skeletal pain,post-dental surgical pain, dental pain, myofascial pain, cancer pain,visceral pain, diabetic pain, muscular pain, post-herpetic neuralgicpain, chronic pelvic pain, endometriosis pain, pelvic inflammatory painand child birth related pain. Acute pain includes, but is not limitedto, acute traumatic pain or post-surgical pain. Chronic pain includes,but is not limited to, neuropathic pain, arthritic pain, osteoarthriticpain, rheumatoid arthritic pain, muscular skeletal pain, dental pain,myofascial pain, cancer pain, diabetic pain, visceral pain, muscularpain, post-herpetic neuralgic pain, chronic pelvic pain, endometriosispain, pelvic inflammatory pain and back pain.

The present disclosure provides use of a compound of Formulae I-XV inthe treatment of pain. The present disclosure provides use of a compoundof Formulae I-XV in the prevention of pain.

The present disclosure provides use of a compound of Formulae I-XV inthe manufacture of a medicament for treatment of pain. The presentdisclosure provides use of a compound of Formulae I-XV in themanufacture of a medicament for prevention of pain.

In another aspect, the embodiments provide a method of treating pain ina patient in need thereof, which comprises administering to such apatient an effective amount of a pharmaceutical composition as describedherein. In another aspect, the embodiments provide a method ofpreventing pain in a patient in need thereof, which comprisesadministering to such a patient an effective amount of a pharmaceuticalcomposition as described herein.

The amount of composition disclosed herein to be administered to apatient to be effective (i.e. to provide blood levels of an opioidsufficient to be effective in the treatment or prophylaxis of pain) willdepend upon the bioavailability of the particular composition, thesusceptibility of the particular composition to enzyme activation in thegut, as well as other factors, such as the species, age, weight, sex,and condition of the patient, manner of administration and judgment ofthe prescribing physician. If the composition also comprises a trypsininhibitor, the amount of composition disclosed herein to be administeredto a patient would also depend on the amount and potency of trypsininhibitor present in the composition. In general, the dose can be suchthat the opioid prodrug is in the range of from 0.01 milligrams perkilogram to 20 milligrams prodrug per kilogram (mg/kg) body weight. Forexample, an opioid prodrug can be administered at a dose equivalent toadministering free opioid in the range of from 0.02-mg/kg to 0.5-mg/kgbody weight or 0.01-mg/kg to 10-mg/kg body weight or 0.01-mg/kg to2-mg/kg body weight. In one embodiment, the composition can beadministered at a dose such that the level of the opioid achieved in theblood is in the range of from 0.5 ng/ml to 200 ng/ml. In one embodiment,the composition can be administered at a dose such that the level of theopioid achieved in the blood is in the range of from 0.5 ng/ml to 20ng/ml. In one embodiment, the composition can be administered at a dosesuch that the level of the opioid achieved in the blood is in the rangeof from 0.5 ng/ml to 10 ng/ml.

As disclosed above, the present disclosure also provides apharmaceutical composition that comprises an opioid prodrug of FormulaeI-XV and a trypsin inhibitor. Such an opioid prodrug comprises apromoiety comprising a trypsin-cleavable moiety that, when cleaved,facilitates release of opioid.

The present disclosure provides use of a compound of Formulae I-XV and atrypsin inhibitor in the treatment of pain. The present disclosureprovides use of a compound of Formulae I-XV and a trypsin inhibitor inthe prevention of pain.

The present disclosure provides use of a compound of Formulae I-XV and atrypsin inhibitor in the manufacture of a medicament for treatment ofpain. The present disclosure provides use of a compound of Formulae I-XVand a trypsin inhibitor in the manufacture of a medicament forprevention of pain.

In another aspect, the embodiments provide a method of treating pain ina patient in need thereof, which comprises administering to such apatient an effective amount of a pharmaceutical composition comprising acompound of Formulae I-XV and a trypsin inhibitor. In another aspect,the embodiments provide a method of preventing pain in a patient in needthereof, which comprises administering to such a patient an effectiveamount of a pharmaceutical composition comprising a compound of FormulaeI-XV and a trypsin inhibitor.

In such pharmaceutical compositions, the amount of a trypsin inhibitorto be administered to the patient to be effective (i.e. to attenuaterelease of an opioid when administration of a compound disclosed hereinalone would lead to overexposure of the opioid) will depend upon theeffective dose of the particular prodrug and the potency of theparticular inhibitor, as well as other factors, such as the species,age, weight, sex and condition of the patient, manner of administrationand judgment of the prescribing physician. In general, the dose ofinhibitor can be in the range of from 0.05 mg to 50 mg per mg of prodrugdisclosed herein. In a certain embodiment, the dose of inhibitor can bein the range of from 0.001 mg to 50 mg per mg of prodrug disclosedherein. In one embodiment, the dose of inhibitor can be in the range offrom 0.01 nanomoles to 100 micromoles per micromole of prodrug disclosedherein.

Representative Embodiments of Dose Units of Prodrug and GI EnzymeInhibitor Having a Desired Pharmacokinetic Profile

The embodiments include a composition that comprises (a) an opioidprodrug of Formulae I-XV, which comprises an opioid covalently bound toa promoiety comprising a GI enzyme-cleavable moiety, wherein cleavage ofthe GI enzyme-cleavable moiety by a GI enzyme mediates release of anopioid, and (b) a GI enzyme inhibitor that interacts with the GI enzymethat mediates enzymatically-controlled release of the opioid from theprodrug following ingestion of the composition. In one embodiment, theGI enzyme is trypsin, the GI enzyme-cleavable moiety is atrypsin-cleavable moiety, and the GI enzyme inhibitor is a trypsininhibitor.

The embodiments include a dose unit comprising a composition, such as apharmaceutical composition, comprising an opioid prodrug of FormulaeI-XV and a GI enzyme inhibitor, where the opioid prodrug of FormulaeI-XV and GI enzyme inhibitor are present in the dose unit in an amounteffective to provide for a pre-selected pharmacokinetic (PK) profilefollowing ingestion. In further embodiments, the pre-selected PK profilecomprises at least one PK parameter value that is less than the PKparameter value of opioid released following ingestion of an equivalentdosage of an opioid prodrug of Formulae I-XV in the absence ofinhibitor. In further embodiments, the PK parameter value is selectedfrom an opioid Cmax value, an opioid exposure value, and a (1/opioidTmax) value.

In certain embodiments, the dose unit provides for a pre-selected PKprofile following ingestion of at least two dose units. In relatedembodiments, the pre-selected PK profile of such dose units is modifiedrelative to the PK profile following ingestion of an equivalent dosageof an opioid prodrug of Formulae I-XV without inhibitor. In relatedembodiments, such a dose unit provides that ingestion of an increasingnumber of the dose units provides for a linear PK profile. In relatedembodiments, such a dose unit provides that ingestion of an increasingnumber of the dose units provides for a nonlinear PK profile. In relatedembodiments, the PK parameter value of the PK profile of such a doseunit is selected from an opioid Cmax value, a (1/opioid Tmax) value, andan opioid exposure value.

The embodiments include methods for treating a patient comprisingadministering any of the compositions, such as pharmaceuticalcompositions, comprising an opioid prodrug of Formulae I-XV and a GIenzyme inhibitor or dose units described herein to a patient in needthereof. The embodiments include methods to reduce side effects of atherapy comprising administering any of such compositions, e.g.,pharmaceutical compositions, or dose units described herein, to apatient in need thereof. The embodiments include methods of improvingpatient compliance with a therapy prescribed by a clinician comprisingdirecting administration of any of such compositions, e.g.,pharmaceutical compositions, or dose units described herein, to apatient in need thereof. Such embodiments can provide for improvedpatient compliance with a prescribed therapy as compared to patientcompliance with a prescribed therapy using drug and/or using prodrugwithout inhibitor as compared to prodrug with inhibitor.

The embodiments include methods of reducing risk of unintended overdoseof an opioid comprising directing administration of any of suchcompositions, e.g., pharmaceutical compositions, or dose units describedherein, to a patient in need of treatment.

The embodiments include methods of making a dose unit comprisingcombining an opioid prodrug of Formulae I-XV and a GI enzyme inhibitorin a dose unit, wherein the opioid prodrug of Formulae I-XV and GIenzyme inhibitor are present in the dose unit in an amount effective toattenuate release of opioid from the opioid prodrug of Formulae I-XV.

The embodiments include methods of deterring misuse or abuse of multipledose units of an opioid prodrug of Formulae I-XV comprising combining anopioid prodrug of Formulae I-XV and a GI enzyme inhibitor in a doseunit, wherein the opioid prodrug of Formulae I-XV and GI enzymeinhibitor are present in the dose unit in an amount effective toattenuate release of an opioid from the opioid prodrug of Formulae I-XVsuch that ingestion of multiples of dose units by a patient does notprovide a proportional release of the opioid. In further embodiments,release of drug is decreased compared to release of drug by anequivalent dosage of prodrug in the absence of inhibitor.

One embodiment is a method for identifying a GI enzyme inhibitor andprodrug of Formulae I-XV suitable for formulation in a dose unit. Such amethod can be conducted as, for example, an in vitro assay, an in vivoassay, or an ex vivo assay. In one embodiment, the GI enzyme inhibitoris a trypsin inhibitor.

The embodiments include methods for identifying a GI enzyme inhibitorand prodrug of Formulae I-XV suitable for formulation in a dose unitcomprising combining a prodrug of Formulae I-XV, a GI enzyme inhibitor,and a GI enzyme in a reaction mixture, and detecting prodrug conversion,wherein a decrease in prodrug conversion in the presence of the GIenzyme inhibitor as compared to prodrug conversion in the absence of theGI enzyme inhibitor indicates the GI enzyme inhibitor and prodrug ofFormulae I-XV are suitable for formulation in a dose unit.

The embodiments include methods for identifying a GI enzyme inhibitorand prodrug of Formulae I-XV suitable for formulation in a dose unitcomprising administering to an animal a GI enzyme inhibitor and prodrugof Formulae I-XV and detecting prodrug conversion, wherein a decrease inopioid conversion in the presence of the GI enzyme inhibitor as comparedto opioid conversion in the absence of the GI enzyme inhibitor indicatesthe GI enzyme inhibitor and prodrug of Formulae I-XV are suitable forformulation in a dose unit. In certain embodiments, administeringcomprises administering to the animal increasing doses of inhibitorco-dosed with a selected fixed dose of prodrug. Detecting prodrugconversion can facilitate identification of a dose of inhibitor and adose of prodrug that provides for a pre-selected pharmacokinetic (PK)profile. Such methods can be conducted as, for example, an in vivo assayor an ex vivo assay.

The embodiments include methods for identifying a GI enzyme inhibitorand prodrug of Formulae I-XV suitable for formulation in a dose unitcomprising administering to an animal tissue a GI enzyme inhibitor andprodrug of Formulae I-XV and detecting prodrug conversion, wherein adecrease in prodrug conversion in the presence of the GI enzymeinhibitor as compared to prodrug conversion in the absence of the GIenzyme inhibitor indicates the GI enzyme inhibitor and prodrug ofFormulae I-XV are suitable for formulation in a dose unit.

Dose Units of Prodrug and Inhibitor Having a Desired PharmacokineticProfile

The present disclosure provides dose units of prodrug and inhibitor thatcan provide for a desired pharmacokinetic (PK) profile. Dose units canprovide a modified PK profile compared to a reference PK profile asdisclosed herein. It will be appreciated that a modified PK profile canprovide for a modified pharmacodynamic (PD) profile. Ingestion ofmultiples of such a dose unit can also provide a desired PK profile.

Unless specifically stated otherwise, “dose unit” as used herein refersto a combination of a GI enzyme-cleavable prodrug (e.g.,trypsin-cleavable prodrug) and a GI enzyme inhibitor (e.g., a trypsininhibitor). A “single dose unit” is a single unit of a combination of aGI enzyme-cleavable prodrug (e.g., trypsin-cleavable prodrug) and a GIenzyme inhibitor (e.g., trypsin inhibitor), where the single dose unitprovide a therapeutically effective amount of drug (i.e., a sufficientamount of drug to effect a therapeutic effect, e.g., a dose within therespective drug's therapeutic window, or therapeutic range). “Multipledose units” or “multiples of a dose unit” or a “multiple of a dose unit”refers to at least two single dose units.

As used herein, a “PK profile” refers to a profile of drug concentrationin blood or plasma. Such a profile can be a relationship of drugconcentration over time (i.e., a “concentration-time PK profile”) or arelationship of drug concentration versus number of doses ingested(i.e., a “concentration-dose PK profile”.) A PK profile is characterizedby PK parameters.

As used herein, a “PK parameter” refers to a measure of drugconcentration in blood or plasma, such as: 1) “drug Cmax”, the maximumconcentration of drug achieved in blood or plasma; 2) “drug Tmax”, thetime elapsed following ingestion to achieve Cmax; and 3) “drugexposure”, the total concentration of drug present in blood or plasmaover a selected period of time, which can be measured using the areaunder the curve (AUC) of a time course of drug release over a selectedperiod of time (t). Modification of one or more PK parameters providesfor a modified PK profile.

For purposes of describing the features of dose units of the presentdisclosure, “PK parameter values” that define a PK profile include drugCmax (e.g., opioid Cmax), total drug exposure (e.g., area under thecurve) (e.g., opioid exposure) and 1/(drug Tmax) (such that a decreased1/Tmax is indicative of a delay in Tmax relative to a reference Tmax)(e.g., 1/opioid Tmax). Thus a decrease in a PK parameter value relativeto a reference PK parameter value can indicate, for example, a decreasein drug Cmax, a decrease in drug exposure, and/or a delayed Tmax.

Dose units of the present disclosure can be adapted to provide for amodified PK profile, e.g., a PK profile that is different from thatachieved from dosing a given dose of prodrug in the absence of inhibitor(i.e., without inhibitor). For example, dose units can provide for atleast one of decreased drug Cmax, delayed drug Tmax and/or decreaseddrug exposure compared to ingestion of a dose of prodrug in the sameamount but in the absence of inhibitor. Such a modification is due tothe inclusion of an inhibitor in the dose unit.

As used herein, “a pharmacodynamic (PD) profile” refers to a profile ofthe efficacy of a drug in a patient (or subject or user), which ischaracterized by PD parameters. “PD parameters” include “drug Emax” (themaximum drug efficacy), “drug EC50” (the concentration of drug at 50% ofthe Emax), and side effects.

FIG. 1 is a schematic illustrating an example of the effect ofincreasing inhibitor concentrations upon the PK parameter drug Cmax fora fixed dose of prodrug. At low concentrations of inhibitor, there maybe no detectable effect on drug release, as illustrated by the plateauportion of the plot of drug Cmax (Y axis) versus inhibitor concentration(X axis). As inhibitor concentration increases, a concentration isreached at which drug release from prodrug is attenuated, causing adecrease in, or suppression of, drug Cmax. Thus, the effect of inhibitorupon a prodrug PK parameter for a dose unit of the present disclosurecan range from undetectable, to moderate, to complete inhibition (i.e.,no detectable drug release).

A dose unit can be adapted to provide for a desired PK profile (e.g., aconcentration-time PK profile) following ingestion of a single dose. Adose unit can be adapted to provide for a desired PK profile (e.g., aconcentration-dose PK profile) following ingestion of multiple doseunits (e.g., at least 2, at least 3, at least 4 or more dose units).

Dose Units Providing Modified PK Profiles

A combination of a prodrug and an inhibitor in a dose unit can provide adesired (or “pre-selected”) PK profile (e.g., a concentration-time PKprofile) following ingestion of a single dose. The PK profile of such adose unit can be characterized by one or more of a pre-selected drugCmax, a pre-selected drug Tmax or a pre-selected drug exposure. The PKprofile of the dose unit can be modified compared to a PK profileachieved from the equivalent dosage of prodrug in the absence ofinhibitor (i.e., a dose that is the same as the dose unit except that itlacks inhibitor).

A modified PK profile can have a decreased PK parameter value relativeto a reference PK parameter value (e.g., a PK parameter value of a PKprofile following ingestion of a dosage of prodrug that is equivalent toa dose unit except without inhibitor). For example, a dose unit canprovide for a decreased drug Cmax, decreased drug exposure, and/ordelayed drug Tmax.

FIG. 2 presents schematic graphs showing examples of modifiedconcentration-time PK profiles of a single dose unit. Panel A is aschematic of drug concentration in blood or plasma (Y axis) following aperiod of time (X axis) after ingestion of prodrug in the absence orpresence of inhibitor. The solid, top line in Panel A provides anexample of drug concentration following ingestion of prodrug withoutinhibitor. The dashed, lower line in Panel A represents drugconcentration following ingestion of the same dose of prodrug withinhibitor. Ingestion of inhibitor with prodrug provides for a decreaseddrug Cmax relative to the drug Cmax that results from ingestion of thesame amount of prodrug in the absence of inhibitor. Panel A alsoillustrates that the total drug exposure following ingestion of prodrugwith inhibitor is also decreased relative to ingestion of the sameamount of prodrug without inhibitor.

Panel B of FIG. 2 provides another example of a dose unit having amodified concentration-time PK profile. As in Panel A, the solid topline represents drug concentration over time in blood or plasmafollowing ingestion of prodrug without inhibitor, while the dashed lowerline represents drug concentration following ingestion of the sameamount of prodrug with inhibitor. In this example, the dose unitprovides a PK profile having a decreased drug Cmax, decreased drugexposure, and a delayed drug Tmax (i.e., decreased (1/drug Tmax)relative to ingestion of the same dose of prodrug without inhibitor.

Panel C of FIG. 2 provides another example of a dose unit having amodified concentration-time PK profile. As in Panel A, the solid linerepresents drug concentration over time in blood or plasma followingingestion of prodrug without inhibitor, while the dashed line representsdrug concentration following ingestion of the same amount of prodrugwith inhibitor. In this example, the dose unit provides a PK profilehaving a delayed drug Tmax (i.e., decreased (1/drug Tmax) relative toingestion of the same dose of prodrug without inhibitor.

Dose units that provide for a modified PK profile (e.g., a decreaseddrug Cmax and/or delayed drug Tmax as compared to, a PK profile of drugor a PK profile of prodrug without inhibitor), find use in tailoring ofdrug dose according to a patient's needs (e.g., through selection of aparticular dose unit and/or selection of a dosage regimen), reduction ofside effects, and/or improvement in patient compliance (as compared toside effects or patient compliance associated with drug or with prodrugwithout inhibitor). As used herein, “patient compliance” refers towhether a patient follows the direction of a clinician (e.g., aphysician) including ingestion of a dose that is neither significantlyabove nor significantly below that prescribed. Such dose units alsoreduce the risk of misuse, abuse or overdose by a patient as compared tosuch risk(s) associated with drug or prodrug without inhibitor. Forexample, dose units with a decreased drug Cmax provide less reward foringestion than does a dose of the same amount of drug, and/or the sameamount of prodrug without inhibitor.

Dose Units Providing Modified PK Profiles Upon Ingestion of MultipleDose Units

A dose unit of the present disclosure can be adapted to provide for adesired PK profile (e.g., a concentration-time PK profile orconcentration-dose PK profile) following ingestion of multiples of adose unit (e.g., at least 2, at least 3, at least 4, or more doseunits). A concentration-dose PK profile refers to the relationshipbetween a selected PK parameter and a number of single dose unitsingested. Such a profile can be dose proportional, linear (a linear PKprofile) or nonlinear (a nonlinear PK profile). A modifiedconcentration-dose PK profile can be provided by adjusting the relativeamounts of prodrug and inhibitor contained in a single dose unit and/orby using a different prodrug and/or inhibitor.

FIG. 3 provides schematics of examples of concentration-dose PK profiles(exemplified by drug Cmax, Y axis) that can be provided by ingestion ofmultiples of a dose unit (X axis) of the present disclosure. Eachprofile can be compared to a concentration-dose PK profile provided byincreasing doses of drug alone, where the amount of drug in the blood orplasma from one dose represents a therapeutically effective amountequivalent to the amount of drug released into the blood or plasma byone dose unit of the disclosure. Such a “drug alone” PK profile istypically dose proportional, having a forty-five degree angle positivelinear slope. It is also to be appreciated that a concentration-dose PKprofile resulting from ingestion of multiples of a dose unit of thedisclosure can also be compared to other references, such as aconcentration-dose PK profile provided by ingestion of an increasingnumber of doses of prodrug without inhibitor wherein the amount of drugreleased into the blood or plasma by a single dose of prodrug in theabsence of inhibitor represents a therapeutically effective amountequivalent to the amount of drug released into the blood or plasma byone dose unit of the disclosure.

As illustrated by the relationship between prodrug and inhibitorconcentration in FIG. 2, a dose unit can include inhibitor in an amountthat does not detectably affect drug release following ingestion.Ingestion of multiples of such a dose unit can provide aconcentration-dose PK profile such that the relationship between numberof dose units ingested and PK parameter value is linear with a positiveslope, which is similar to, for example, a dose proportional PK profileof increasing amounts of prodrug alone. Panel A of FIG. 3 depicts such aprofile. Dose units that provide a concentration-dose PK profile havingsuch an undetectable change in drug Cmax in vivo compared to the profileof prodrug alone can find use in thwarting enzyme conversion of prodrugfrom a dose unit that has sufficient inhibitor to reduce or prevent invitro cleavage of the enzyme-cleavable prodrug by its respective enzyme.

Panel B in FIG. 3 represents a concentration-dose PK profile such thatthe relationship between the number of dose units ingested and a PKparameter value is linear with positive slope, where the profileexhibits a reduced slope relative to panel A. Such a dose unit providesa profile having a decreased PK parameter value (e.g., drug Cmax)relative to a reference PK parameter value exhibiting doseproportionality.

Concentration-dose PK profiles following ingestion of multiples of adose unit can be non-linear. Panel C in FIG. 3 represents an example ofa non-linear, biphasic concentration-dose PK profile. In this example,the biphasic concentration-dose PK profile contains a first phase overwhich the concentration-dose PK profile has a positive rise, and then asecond phase over which the relationship between number of dose unitsingested and a PK parameter value (e.g., drug Cmax) is relatively flat(substantially linear with zero slope). For such a dose unit, forexample, drug Cmax can be increased for a selected number of dose units(e.g., 2, 3, or 4 dose units). However, ingestion of additional doseunits does not provide for a significant increase in drug Cmax.

Panel D in FIG. 3 represents another example of a non-linear, biphasicconcentration-dose PK profile. In this example, the biphasicconcentration-dose PK profile is characterized by a first phase overwhich the concentration-dose PK profile has a positive rise and a secondphase over which the relationship between number of dose units ingestedand a PK parameter value (e.g., drug Cmax) declines. Dose units thatprovide this concentration-dose PK profile provide for an increase indrug Cmax for a selected number of ingested dose units (e.g., 2, 3, or 4dose units). However, ingestion of further additional dose units doesnot provide for a significant increase in drug Cmax and instead providesfor decreased drug Cmax.

Panel E in FIG. 3 represents a concentration-dose PK profile in whichthe relationship between the number of dose units ingested and a PKparameter (e.g., drug Cmax) is linear with zero slope. Such dose unitsdo not provide for a significant increase or decrease in drug Cmax withingestion of multiples of dose units.

Panel F in FIG. 3 represents a concentration-dose PK profile in whichthe relationship between number of dose units ingested and a PKparameter value (e.g., drug Cmax) is linear with a negative slope. Thusdrug Cmax decreases as the number of dose units ingested increases.

Dose units that provide for concentration-dose PK profiles whenmultiples of a dose unit are ingested find use in tailoring of a dosageregimen to provide a therapeutic level of released drug while reducingthe risk of overdose, misuse, or abuse. Such reduction in risk can becompared to a reference, e.g., to administration of drug alone orprodrug alone. In one embodiment, risk is reduced compared toadministration of a drug or prodrug that provides a proportionalconcentration-dose PK profile. A dose unit that provides for aconcentration-dose PK profile can reduce the risk of patient overdosethrough inadvertent ingestion of dose units above a prescribed dosage.Such a dose unit can reduce the risk of patient misuse (e.g., throughself-medication). Such a dose unit can discourage abuse throughdeliberate ingestion of multiple dose units. For example, a dose unitthat provides for a biphasic concentration-dose PK profile can allow foran increase in drug release for a limited number of dose units ingested,after which an increase in drug release with ingestion of more doseunits is not realized. In another example, a dose unit that provides fora concentration-dose PK profile of zero slope can allow for retention ofa similar drug release profile regardless of the number of dose unitsingested.

Ingestion of multiples of a dose unit can provide for adjustment of a PKparameter value relative to that of ingestion of multiples of the samedose (either as drug alone or as a prodrug) in the absence of inhibitorsuch that, for example, ingestion of a selected number (e.g., 2, 3, 4 ormore) of a single dose unit provides for a decrease in a PK parametervalue compared to ingestion of the same number of doses in the absenceof inhibitor.

Pharmaceutical compositions include those having an inhibitor to providefor protection of a therapeutic compound from degradation in the GItract. Inhibitor can be combined with a drug (i.e., not a prodrug) toprovide for protection of the drug from degradation in the GI system. Inthis example, the composition of inhibitor and drug provide for amodified PK profile by increasing a PK parameter. Inhibitor can also becombined with a prodrug that is susceptible to degradation by a GIenzyme and has a site of action outside the GI tract. In thiscomposition, the inhibitor protects ingested prodrug in the GI tractprior to its distribution outside the GI tract and cleavage at a desiredsite of action.

Methods Used to Define Relative Amounts of Prodrug and Inhibitor in aDose Unit

Dose units that provide for a desired PK profile, such as a desiredconcentration-time PK profile and/or a desired concentration-dose PKprofile, can be made by combining a prodrug and an inhibitor in a doseunit in relative amounts effective to provide for release of drug thatprovides for a desired drug PK profile following ingestion by a patient.

Prodrugs can be selected as suitable for use in a dose unit bydetermining the GI enzyme-mediated drug release competency of theprodrug. This can be accomplished in vitro, in vivo or ex vivo.

In vitro assays can be conducted by combining a prodrug with a GI enzyme(e.g., trypsin) in a reaction mixture. The GI enzyme can be provided inthe reaction mixture in an amount sufficient to catalyze cleavage of theprodrug. Assays are conducted under suitable conditions, and optionallymay be under conditions that mimic those found in a GI tract of asubject, e.g., human. “Prodrug conversion” refers to release of drugfrom prodrug. Prodrug conversion can be assessed by detecting a level ofa product of prodrug conversion (e.g., released drug) and/or bydetecting a level of prodrug that is maintained in the presence of theGI enzyme. Prodrug conversion can also be assessed by detecting the rateat which a product of prodrug conversion occurs or the rate at whichprodrug disappears. An increase in released drug, or a decrease inprodrug, indicate prodrug conversion has occurred. Prodrugs that exhibitan acceptable level of prodrug conversion in the presence of the GIenzyme within an acceptable period of time are suitable for use in adose unit in combination with an inhibitor of the GI enzyme that isshown to mediate prodrug conversion.

In vivo assays can assess the suitability of a prodrug for use in a doseunit by administration of the prodrug to an animal (e.g., a human ornon-human animal, e.g., rat, dog, pig, etc.). Such administration can beenteral (e.g., oral administration). Prodrug conversion can be detectedby, for example, detecting a product of prodrug conversion (e.g.,released drug or a metabolite of released drug) or detecting prodrug inblood or plasma of the animal at a desired time point(s) followingadministration.

Ex vivo assays, such as a gut loop or inverted gut loop assay, canassess the suitability of a prodrug for use in a dose unit by, forexample, administration of the prodrug to a ligated section of theintestine of an animal. Prodrug conversion can be detected by, forexample, detecting a product of prodrug conversion (e.g., released drugor a metabolite of released drug) or detecting prodrug in the ligatedgut loop of the animal at a desired time point(s) followingadministration.

Inhibitors are generally selected based on, for example, activity ininteracting with the GI enzyme(s) that mediate release of drug from aprodrug with which the inhibitor is to be co-dosed. Such assays can beconducted in the presence of enzyme either with or without prodrug.Inhibitors can also be selected according to properties such ashalf-life in the GI system, potency, avidity, affinity, molecular sizeand/or enzyme inhibition profile (e.g., steepness of inhibition curve inan enzyme activity assay, inhibition initiation rate). Inhibitors foruse in prodrug-inhibitor combinations can be selected through use of invitro, in vivo and/or ex vivo assays.

One embodiment is a method for identifying a prodrug and a GI enzymeinhibitor suitable for formulation in a dose unit wherein the methodcomprises combining a prodrug (e.g., a opioid prodrug), a GI enzymeinhibitor (e.g., a trypsin inhibitor), and a GI enzyme (e.g., trypsin)in a reaction mixture and detecting prodrug conversion. Such acombination is tested for an interaction between the prodrug, inhibitorand enzyme, i.e., tested to determine how the inhibitor will interactwith the enzyme that mediates enzymatically-controlled release of thedrug from the prodrug. In one embodiment, a decrease in prodrugconversion in the presence of the GI enzyme inhibitor as compared toprodrug conversion in the absence of the GI enzyme inhibitor indicatesthe prodrug and GI enzyme inhibitor are suitable for formulation in adose unit. Such a method can be an in vitro assay.

One embodiment is a method for identifying a prodrug and a GI enzymeinhibitor suitable for formulation in a dose unit wherein the methodcomprises administering to an animal a prodrug and a GI enzyme inhibitorand detecting prodrug conversion. In one embodiment, a decrease inprodrug conversion in the presence of the GI enzyme inhibitor ascompared to prodrug conversion in the absence of the GI enzyme inhibitorindicates the prodrug and GI enzyme inhibitor are suitable forformulation in a dose unit. Such a method can be an in vivo assay; forexample, the prodrug and GI enzyme inhibitor can be administered orally.Such a method can also be an ex vivo assay; for example, the prodrug andGI enzyme inhibitor can be administered orally or to a tissue, such asan intestine, that is at least temporarily exposed. Detection can occurin the blood or plasma or respective tissue. As used herein, tissuerefers to the tissue itself and can also refer to contents within thetissue.

One embodiment is a method for identifying a prodrug and a GI enzymeinhibitor suitable for formulation in a dose unit wherein the methodcomprises administering a prodrug and a gastrointestinal (GI) enzymeinhibitor to an animal tissue that has removed from an animal anddetecting prodrug conversion. In one embodiment, a decrease in prodrugconversion in the presence of the GI enzyme inhibitor as compared toprodrug conversion in the absence of the GI enzyme inhibitor indicatesthe prodrug and GI enzyme inhibitor are suitable for formulation in adose unit.

In vitro assays can be conducted by combining a prodrug, an inhibitorand a GI enzyme in a reaction mixture. The GI enzyme can be provided inthe reaction mixture in an amount sufficient to catalyze cleavage of theprodrug, and assays conducted under suitable conditions, optionallyunder conditions that mimic those found in a GI tract of a subject,e.g., human. Prodrug conversion can be assessed by detecting a level ofa product of prodrug conversion (e.g., released drug) and/or bydetecting a level of prodrug maintained in the presence of the GIenzyme. Prodrug conversion can also be assessed by detecting the rate atwhich a product of prodrug conversion occurs or the rate at whichprodrug disappears. Prodrug conversion that is modified in the presenceof inhibitor as compared to a level of prodrug conversion in the absenceof inhibitor indicates the inhibitor is suitable for attenuation ofprodrug conversion and for use in a dose unit. Reaction mixtures havinga fixed amount of prodrug and increasing amounts of inhibitor, or afixed amount of inhibitor and increasing amounts of prodrug, can be usedto identify relative amounts of prodrug and inhibitor which provide fora desired modification of prodrug conversion.

In vivo assays can assess combinations of prodrugs and inhibitors byco-dosing of prodrug and inhibitor to an animal. Such co-dosing can beenteral. “Co-dosing” refers to administration of prodrug and inhibitoras separate doses or a combined dose (i.e., in the same formulation).Prodrug conversion can be detected by, for example, detecting a productof prodrug conversion (e.g., released drug or drug metabolite) ordetecting prodrug in blood or plasma of the animal at a desired timepoint(s) following administration. Combinations of prodrug and inhibitorcan be identified that provide for a prodrug conversion level thatyields a desired PK profile as compared to, for example, prodrug withoutinhibitor.

Combinations of relative amounts of prodrug and inhibitor that providefor a desired PK profile can be identified by dosing animals with afixed amount of prodrug and increasing amounts of inhibitor, or with afixed amount of inhibitor and increasing amounts of prodrug. One or morePK parameters can then be assessed, e.g., drug Cmax, drug Tmax, and drugexposure. Relative amounts of prodrug and inhibitor that provide for adesired PK profile are identified as amounts of prodrug and inhibitorfor use in a dose unit. The PK profile of the prodrug and inhibitorcombination can be, for example, characterized by a decreased PKparameter value relative to prodrug without inhibitor. A decrease in thePK parameter value of an inhibitor-to-prodrug combination (e.g., adecrease in drug Cmax, a decrease in 1/drug Tmax (i.e., a delay in drugTmax) or a decrease in drug exposure) relative to a corresponding PKparameter value following administration of prodrug without inhibitorcan be indicative of an inhibitor-to-prodrug combination that canprovide a desired PK profile. Assays can be conducted with differentrelative amounts of inhibitor and prodrug.

In vivo assays can be used to identify combinations of prodrug andinhibitor that provide for dose units that provide for a desiredconcentration-dose PK profile following ingestion of multiples of thedose unit (e.g., at least 2, at least 3, at least 4 or more). Ex vivoassays can be conducted by direct administration of prodrug andinhibitor into a tissue and/or its contents of an animal, such as theintestine, including by introduction by injection into the lumen of aligated intestine (e.g., a gut loop, or intestinal loop, assay, or aninverted gut assay). An ex vivo assay can also be conducted by excisinga tissue and/or its contents from an animal and introducing prodrug andinhibitor into such tissues and/or contents.

For example, a dose of prodrug that is desired for a single dose unit isselected (e.g., an amount that provides an efficacious plasma druglevel). A multiple of single dose units for which a relationship betweenthat multiple and a PK parameter to be tested is then selected. Forexample, if a concentration-dose PK profile is to be designed foringestion of 2, 3, 4, 5, 6, 7, 8, 9 or 10 dose units, then the amount ofprodrug equivalent to ingestion of that same number of dose units isdetermined (referred to as the “high dose”). The multiple of dose unitscan be selected based on the number of ingested pills at which drug Cmaxis modified relative to ingestion of the single dose unit. If, forexample, the profile is to provide for abuse deterrence, then a multipleof 10 can be selected, for example. A variety of different inhibitors(e.g., from a panel of inhibitors) can be tested using differentrelative amounts of inhibitor and prodrug. Assays can be used toidentify suitable combination(s) of inhibitor and prodrug to obtain asingle dose unit that is therapeutically effective, wherein such acombination, when ingested as a multiple of dose units, provides amodified PK parameter compared to ingestion of the same multiple of drugor prodrug alone (wherein a single dose of either drug or prodrug alonereleases into blood or plasma the same amount of drug as is released bya single dose unit).

Increasing amounts of inhibitor are then co-dosed to animals with thehigh dose of prodrug. The dose level of inhibitor that provides adesired drug Cmax following ingestion of the high dose of prodrug isidentified and the resultant inhibitor-to-prodrug ratio determined.

Prodrug and inhibitor are then co-dosed in amounts equivalent to theinhibitor-to-prodrug ratio that provided the desired result at the highdose of prodrug. The PK parameter value of interest (e.g., drug Cmax) isthen assessed. If a desired PK parameter value results followingingestion of the single dose unit equivalent, then single dose unitsthat provide for a desired concentration-dose PK profile are identified.For example, where a zero dose linear profile is desired, the drug Cmaxfollowing ingestion of a single dose unit does not increasesignificantly following ingestion of a multiple number of the singledose units.

Methods for Manufacturing, Formulating, and Packaging Dose Units

Dose units of the present disclosure can be made using manufacturingmethods available in the art and can be of a variety of forms suitablefor enteral (including oral, buccal and sublingual) administration, forexample as a tablet, capsule, thin film, powder, suspension, solution,syrup, dispersion or emulsion. The dose unit can contain componentsconventional in pharmaceutical preparations, e.g. one or more carriers,binders, lubricants, excipients (e.g., to impart controlled releasecharacteristics), pH modifiers, flavoring agents (e.g., sweeteners),bulking agents, coloring agents or further active agents. Dose units ofthe present disclosure can include can include an enteric coating orother component(s) to facilitate protection from stomach acid, wheredesired.

Dose units can be of any suitable size or shape. The dose unit can be ofany shape suitable for enteral administration, e.g., ellipsoid,lenticular, circular, rectangular, cylindrical, and the like.

Dose units provided as dry dose units can have a total weight of fromabout 1 microgram to about 1 gram, and can be from about 5 micrograms to1.5 grams, from about 50 micrograms to 1 gram, from about 100 microgramsto 1 gram, from 50 micrograms to 750 milligrams, and may be from about 1microgram to 2 grams.

Dose units can comprise components in any relative amounts. For example,dose units can be from about 0.1% to 99% by weight of active ingredients(i.e., prodrug and inhibitor) per total weight of dose unit (0.1% to 99%total combined weight of prodrug and inhibitor per total weight ofsingle dose unit). In some embodiments, dose units can be from 10% to50%, from 20% to 40%, or about 30% by weight of active ingredients pertotal weight dose unit.

Dose units can be provided in a variety of different forms andoptionally provided in a manner suitable for storage. For example, doseunits can be disposed within a container suitable for containing apharmaceutical composition. The container can be, for example, a bottle(e.g., with a closure device, such as a cap), a blister pack (e.g.,which can provide for enclosure of one or more dose units per blister),a vial, flexible packaging (e.g., sealed Mylar or plastic bags), anampule (for single dose units in solution), a dropper, thin film, a tubeand the like.

Containers can include a cap (e.g., screw cap) that is removablyconnected to the container over an opening through which the dose unitsdisposed within the container can be accessed.

Containers can include a seal which can serve as a tamper-evident and/ortamper-resistant element, which seal is disrupted upon access to a doseunit disposed within the container. Such seal elements can be, forexample, a frangible element that is broken or otherwise modified uponaccess to a dose unit disposed within the container. Examples of suchfrangible seal elements include a seal positioned over a containeropening such that access to a dose unit within the container requiresdisruption of the seal (e.g., by peeling and/or piercing the seal).Examples of frangible seal elements include a frangible ring disposedaround a container opening and in connection with a cap such that thering is broken upon opening of the cap to access the dose units in thecontainer.

Dry and liquid dose units can be placed in a container (e.g., bottle orpackage, e.g., a flexible bag) of a size and configuration adapted tomaintain stability of dose units over a period during which the doseunits are dispensed into a prescription. For example, containers can besized and configured to contain 10, 20, 30, 40, 50, 60, 70, 80, 90, 100or more single dry or liquid dose units. The containers can be sealed orresealable. The containers can packaged in a carton (e.g., for shipmentfrom a manufacturer to a pharmacy or other dispensary). Such cartons canbe boxes, tubes, or of other configuration, and may be made of anymaterial (e.g., cardboard, plastic, and the like). The packaging systemand/or containers disposed therein can have one or more affixed labels(e.g., to provide information such as lot number, dose unit type,manufacturer, and the like).

The container can include a moisture barrier and/or light barrier, e.g.,to facilitate maintenance of stability of the active ingredients in thedose units contained therein. Where the dose unit is a dry dose unit,the container can include a desiccant pack which is disposed within thecontainer. The container can be adapted to contain a single dose unit ormultiples of a dose unit. The container can include a dispensing controlmechanism, such as a lock out mechanism that facilitates maintenance ofdosing regimen.

The dose units can be provided in solid or semi-solid form, and can be adry dose unit. “Dry dose unit” refers to a dose unit that is in otherthan in a completely liquid form. Examples of dry dose units include,for example, tablets, capsules (e.g., solid capsules, capsulescontaining liquid), thin film, microparticles, granules, powder and thelike. Dose units can be provided as liquid dose units, where the doseunits can be provided as single or multiple doses of a formulationcontaining prodrug and inhibitor in liquid form. Single doses of a dryor liquid dose unit can be disposed within a sealed container, andsealed containers optionally provided in a packaging system, e.g., toprovide for a prescribed number of doses, to provide for shipment ofdose units, and the like.

Dose units can be formulated such that the prodrug and inhibitor arepresent in the same carrier, e.g., solubilized or suspended within thesame matrix. Alternatively, dose units can be composed of two or moreportions, where the prodrug and inhibitor can be provided in the same ordifferent portions, and can be provided in adjacent or non-adjacentportions.

Dose units can be provided in a container in which they are disposed,and may be provided as part of a packaging system (optionally withinstructions for use). For example, dose units containing differentamounts of prodrug can be provided in separate containers, whichcontainers can be disposed with in a larger container (e.g., tofacilitate protection of dose units for shipment). For example, one ormore dose units as described herein can be provided in separatecontainers, where dose units of different composition are provided inseparate containers, and the separate containers disposed within packagefor dispensing.

In another example, dose units can be provided in a double-chambereddispenser where a first chamber contains a prodrug formulation and asecond chamber contains an inhibitor formulation. The dispenser can beadapted to provide for mixing of a prodrug formulation and an inhibitorformulation prior to ingestion. For example, the two chambers of thedispenser can be separated by a removable wall (e.g., frangible wall)that is broken or removed prior to administration to allow mixing of theformulations of the two chambers. The first and second chambers canterminate into a dispensing outlet, optionally through a common chamber.The formulations can be provided in dry or liquid form, or a combinationthereof. For example, the formulation in the first chamber can be liquidand the formulation in the second chamber can be dry, both can be dry,or both can be liquid.

Dose units that provide for controlled release of prodrug, of inhibitor,or of both prodrug and inhibitor are contemplated by the presentdisclosure, where “controlled release” refers to release of one or bothof prodrug and inhibitor from the dose unit over a selected period oftime and/or in a pre-selected manner.

Methods of Use of Dose Units

Dose units are advantageous because they find use in methods to reduceside effects and/or improve tolerability of drugs to patients in needthereof by, for example, limiting a PK parameter as disclosed herein.The present disclosure thus provides methods to reduce side effects byadministering a dose unit of the present disclosure to a patient in needso as to provide for a reduction of side effects as compared to thoseassociated with administration of drug and/or as compared toadministration of prodrug without inhibitor. The present disclosure alsoprovides methods to improve tolerability of drugs by administering adose unit of the present disclosure to a patient in need so as toprovide for improvement in tolerability as compared to administration ofdrug and/or as compared to administration of prodrug without inhibitor.

Dose units find use in methods for increasing patient compliance of apatient with a therapy prescribed by a clinician, where such methodsinvolve directing administration of a dose unit described herein to apatient in need of therapy so as to provide for increased patientcompliance as compared to a therapy involving administration of drugand/or as compared to administrations of prodrug without inhibitor. Suchmethods can help increase the likelihood that a clinician-specifiedtherapy occurs as prescribed.

Dose units can provide for enhanced patient compliance and cliniciancontrol. For example, by limiting a PK parameter (e.g., such as drugCmax or drug exposure) when multiples (e.g., two or more, three or more,or four or more) dose units are ingested, a patient requiring a higherdose of drug must seek the assistance of a clinician. The dose units canprovide for control of the degree to which a patient can readily“self-medicate”, and further can provide for the patient to adjust doseto a dose within a permissible range. Dose units can provide for reducedside effects, by for example, providing for delivery of drug at anefficacious dose but with a modified PK profile over a period oftreatment, e.g., as defined by a decreased PK parameter (e.g., decreaseddrug Cmax, decreased drug exposure).

Dose units find use in methods to reduce the risk of unintended overdoseof drug that can follow ingestion of multiple doses taken at the sametime or over a short period of time. Such methods of the presentdisclosure can provide for reduction of risk of unintended overdose ascompared to risk of unintended overdose of drug and/or as compared torisk of unintended overdose of prodrug without inhibitor. Such methodsinvolve directing administration of a dosage described herein to apatient in need of drug released by conversion of the prodrug. Suchmethods can help avoid unintended overdosing due to intentional orunintentional misuse of the dose unit.

The present disclosure provides methods to reduce misuse and abuse of adrug, as well as to reduce risk of overdose, that can accompanyingestion of multiples of doses of a drug, e.g., ingested at the sametime. Such methods generally involve combining in a dose unit a prodrugand an inhibitor of a GI enzyme that mediates release of drug from theprodrug, where the inhibitor is present in the dose unit in an amounteffective to attenuate release of drug from the prodrug, e.g., followingingestion of multiples of dose units by a patient. Such methods providefor a modified concentration-dose PK profile while providingtherapeutically effective levels from a single dose unit, as directed bythe prescribing clinician. Such methods can provide for, for example,reduction of risks that can accompany misuse and/or abuse of a prodrug,particularly where conversion of the prodrug provides for release of anarcotic or other drug of abuse (e.g., opioid). For example, when theprodrug provides for release of a drug of abuse, dose units can providefor reduction of reward that can follow ingestion of multiples of doseunits of a drug of abuse.

Dose units can provide clinicians with enhanced flexibility inprescribing drug. For example, a clinician can prescribe a dosageregimen involving different dose strengths, which can involve two ormore different dose units of prodrug and inhibitor having differentrelative amounts of prodrug, different amounts of inhibitor, ordifferent amounts of both prodrug and inhibitor. Such different strengthdose units can provide for delivery of drug according to different PKparameters (e.g., drug exposure, drug Cmax, and the like as describedherein). For example, a first dose unit can provide for delivery of afirst dose of drug following ingestion, and a second dose unit canprovide for delivery of a second dose of drug following ingestion. Thefirst and second prodrug doses of the dose units can be differentstrengths, e.g., the second dose can be greater than the first dose. Aclinician can thus prescribe a collection of two or more, or three ormore dose units of different strengths, which can be accompanied byinstructions to facilitate a degree of self-medication, e.g., toincrease delivery of an opioid drug according to a patient's needs totreat pain.

Thwarting Tampering by Trypsin Mediated Release of Opioid from Prodrugs

The disclosure provides for a composition comprising a compounddisclosed herein and a trypsin inhibitor that reduces drug abusepotential. A trypsin inhibitor can thwart the ability of a user to applytrypsin to effect the release of an opioid from the opioid prodrug invitro. For example, if an abuser attempts to incubate trypsin with acomposition of the embodiments that includes an opioid prodrug and atrypsin inhibitor, the trypsin inhibitor can reduce the action of theadded trypsin, thereby thwarting attempts to release the opioid forpurposes of abuse.

EXAMPLES

The following examples are put forth so as to provide those of ordinaryskill in the art with a complete disclosure and description of how tomake and use the embodiments, and are not intended to limit the scope ofwhat the inventors regard as their invention nor are they intended torepresent that the experiments below are all or the only experimentsperformed. Efforts have been made to ensure accuracy with respect tonumbers used (e.g. amounts, temperature, etc.) but some experimentalerrors and deviations should be accounted for. Unless indicatedotherwise, parts are parts by weight, molecular weight is weight averagemolecular weight, temperature is in degrees Celsius, and pressure is ator near atmospheric. Standard abbreviations may be used.

Synthesis of Ketone-Modified Opioid Prodrugs Example 1 Synthesis ofoxycodone 6-(N-methyl-N-(2-amino)ethylcarbamate (Compound KC-19)

Preparation of Compound A

2-(Aminoethyl)-methyl-carbamic acid benzyl ester (2.0 g, 9.6 mmol) wasdissolved in dichloroethene (DCE) (20 mL) at room temperature. Triethylamine (NEt₃) (1.40 mL, 11.5 mmol) was added, followed by di-tert-butyldicarbonate (BOC₂O) (10.5 g, 48 mmol) and dimethylaminopyridine (DMAP)(120 mg). The reaction mixture was stirred at room temperature undernitrogen (N₂) for 2 h and then heated at 60° C. for 16 h. The reactionmixture was then concentrated. The residue was purified by silica gelchromatography, using 4/1 hexanes/EtOAc, to give Compound A in 86% yield(3.4 g, 8.3 mmol). MS: (m/z) calc: 408.2, observed (M+Na⁺) 431.9.

Preparation of Compound B

Compound A (1.3 g, 3.18 mmol) was dissolved in methanol/EtOAc (10 mL/3mL respectively). The mixture was degassed and saturated with N₂.Palladium on carbon (Pd/C) (330 mg, 5% on carbon) was added. The mixturewas shaken in a Parr hydrogenator flask (50 psi H₂) for 4 h. The mixturewas then filtered through a celite pad, and the filtrate wasconcentrated to give Compound B (1.08 g, yield exceeded quantitative).Compound B was used without further purification.

Preparation of Compound C

Compound B (500 mg, 1.82 mmol) and NEt₃ (0.4 mL, 2.74 mmol) were mixedtogether in dichloromethane (4 mL). The mixture was added to apre-chilled 0° C. solution of phosgene (5.5 mL, 0.5 M in toluene). Thereaction mixture was stirred at 0° C. for 1 h, followed by dilution withether (20 mL) and filtration through filter paper. The filtrate wasconcentrated and passed through a short silica gel column (10 cm×3 cm),and eluted with 3/1 hexanes/EtOAc. The fractions were concentrated togive N,N-Bis(tert-butyl)N′-2-(chlorocarbonyl(methyl)amino)ethylcarbamate (Compound C) as acolorless solid in quantitative yield (615 mg, 1.82 mmol). MS: (m/z)calc: 336.1, observed (M+Na⁺) 359.8.

Synthesis of Oxycodone 6-(N-methyl-N-(2-amino)ethylcarbamate (CompoundKC-19)

Oxycodone free base (6.5 g, 20.6 mmol) was dissolved in dry, degassedtetrahydrofuran (120 mL), and the mixture was cooled to −10° C. using adry ice/acetone bath. Potassium bis(trimethylsilyl)amide (KHMDS) (103.0mL, 51.6 mmol, 0.5 M in toluene) was added via cannula. The mixture wasstirred under N₂ at below −5° C. for 30 min. N,N-Bis(tert-butyl)N′-2-(chlorocarbonyl(methyl)amino)ethylcarbamate (8.0 g, 23.7 mmol),(Compound C) in THF (30 mL) was then added via cannula over 15 min. Themixture was stirred at −5° C. for 30 min. Another portion of carbamoylchloride (4.0 g, 11.9 mmol) in THF (10 mL) was added. The reaction wasstirred at room temperature for 2 h. Sodium bicarbonate (10 mL, sat.aq.) was added. The mixture was concentrated under vacuum to half of itsinitial volume. EtOAc (50 mL) was added, and layers were separated. Theorganic phase was further washed with water (3×20 mL) and brine (40 mL),and then was concentrated. The residue was purified by silica gelchromatography, using DCM/MeOH (gradient 100/1 to 100/15) to afford awhite foam in 55% yield (7.0 g, 13.4 mmol). This material was dissolvedin a 1:1 mixture of DCM/trifluoroacetic acid (TFA) (20 mL/20 mL) at roomtemperature and stirred for 1 h. The solution was then concentratedunder vacuum to afford a TFA salt of oxycodone6-(N-methyl-N-(2-amino)ethylcarbamate (Compound KC-19) as a thick oil(7.3 g, 11.4 mmol, 99% purity). MS: (m/z) calc: 415.2, observed (M+H⁺)416.5.

Example 2 Synthesis ofN-1-[2-(oxycodone-6-enol-carbonyl-methyl-amino)-ethylamine]-L-arginine-malonate(Compound KC-3) [also named:N-{(S)-4-guanidino-1-[2-(methyl-[(5R,9R,13S,14S)-4,5a-epoxy-6,7-didehydro-14-hydroxy-3-methoxy-17-methylmorphinan-6-oxy]carbonyl-amino)-ethylcarbamoyl]-butyl}-malonate]

Preparation of Compound D

A solution of N-methylethylenediamine (27.0 g, 364 mmol) and ethyltrifluoroacetate (96.6 mL, 812 mmol) in a mixture of ACN (350 mL) andwater (7.8 mL, 436 mmol) was refluxed with stirring overnight. Solventswere evaporated under vacuum. The residue was re-evaporated with i-PrOH(3×100 mL), followed by heat-cool crystallization from DCM (500 mL).Formed crystals were filtered, washed with DCM and dried under vacuum toprovide Compound D (88.3 g, 85%) as white solid powder.

Preparation of Compound E

A solution of Compound D (88.2 g, 311 mmol) and DIEA (54.1 mL, 311 mmol)in THF (350 mL) was cooled in an ice bath, followed by the addition of asolution of N-(benzyloxycarbonyl)succinimide (76.6 g, 307 mmol) in THF(150 mL) dropwise over the period of 20 min. The temperature of thereaction mixture was raised to ambient temperature and stirring wascontinued for an additional 30 min. Solvents were then evaporated andthe resulting residue was dissolved in EtOAc (600 mL). The organic layerwas extracted with 5% aq. NaHCO₃ (2×150 mL) and brine (150 mL). Theorganic layer was evaporated to provide Compound E as yellowish oil.LC-MS [M+H] 305.1 (C₁₃H₁₅F₃N₂O₃+H, calc: 305.3). Compound E was useddirectly in the next reaction without purification as a MeOH solution.

Preparation of Compound F

To a solution of Compound E (˜311 mmol) in MeOH (1.2 L) was added asolution of LiOH (14.9 g, 622 mmol) in water (120 mL). The reactionmixture was stirred at ambient temperature for 3 h. Solvents wereevaporated to 75% of the initial volume followed by dilution with water(400 mL). The solution was extracted with EtOAc (2×300 mL). The organiclayer was washed with brine (200 mL), dried over MgSO₄ and evaporatedunder vacuum. The residue was dissolved in ether (300 mL) and treatedwith 2 N HCl/ether (200 mL). Formed precipitate was filtrated, washedwith ether and dried under vacuum to provide the hydrochloric salt ofCompound F (67.8 g, 89%) as a white solid. LC-MS [M+H] 209.0(C₁₁H₁₆N₂O₂+H, calc: 209.3). Compound F was used directly in the nextreaction without purification as a DMF solution.

Preparation of Compound G

A solution of Boc-Arg(Pbf)-OH (16.0 g, ˜30.4 mmol), Compound Fhydrochloride (8.2 g, 33.4 mmol), and DIEA (16.9 mL, 97.2 mmol) in DMF(150 mL) was cooled in an ice bath followed by the addition of asolution of HATU (13.8 g, 36.4 mmol) dropwise over 20 min. Thetemperature of the reaction mixture was raised to ambient temperature,and stirring was continued for an additional 1 h. The reaction mixturewas diluted with EtOAc (1 L) and extracted with water (3×200 mL) andbrine (200 mL). The organic layer was dried over MgSO₄ and evaporated toprovide Compound G (24.4 g, yield exceeded quantitative) as a yellowishoil. LC-MS [M+H] 717.4 (C₃₅H₅₂N₆O₈S+H, calc: 717.9). Compound G was useddirectly in the next reaction without purification as a dioxanesolution.

Preparation of Compound H

Compound G (24.4 g, ˜30.4 mmol) was dissolved in dioxane (150 mL) andtreated with 4 N HCl/dioxane (150 mL, 600 mmol) at ambient temperaturefor 1 h. The solvent was then evaporated. The residue was suspended ini-PrOH (100 mL), and the mixture was evaporated (procedure was repeatedtwice). The residue was then dried under vacuum to provide Compound H(21.1 g, yield exceeded quantitative) as a yellowish solid. LC-MS [M+H]617.5 (C₃₀H₄₄N₆O₆S+H, calc: 617.8). Compound H was used directly in thenext reaction without purification as a DMF solution.

Preparation of Compound I

A solution of Compound H (21.1 g, ˜30.4 mmol), mono-tert-butyl malonate(5.9 mL, 36.7 mmol), BOP (16.2 g, 36.7 mmol) and DIEA (14.9 mL, 83.5mmol) in DMF (100 mL) was maintained at ambient temperature for 1 h. Thereaction mixture was diluted with EtOAc (1 L) and extracted with water(500 mL), 5% aq. NaHCO₃ (500 mL), water (3×500 mL) and brine (500 mL).The organic layer was dried over MgSO₄, filtered, and then evaporated toprovide Compound I (24.5 g, 97%) as a yellowish amorphous solid. LC-MS[M+H] 759.6 (C₃₇H₅₄N₆O₉S+H, calc: 759.9). Compound I was used withoutfurther purification.

Preparation of Compound J

Compound I (12.3 g, 16.7 mmol) was dissolved in methanol (100 mL)followed by the addition of a Pd/C (5% wt, 2.0 g) suspension in water (2mL). The reaction mixture was subjected to hydrogenation (Parrapparatus, 70 psi H₂) at ambient temperature for 1 h. The catalyst wasthen filtered and washed with methanol. The filtrate was evaporatedunder vacuum to provide Compound J (10.0 g, 99%) as a colorlessamorphous solid. LC-MS [M+H] 625.5 (C₂₉H₄₈N₆O₇S+H, calc: 625.8).Compound J was used without further purification.

Preparation of Oxycodone Free Base

Oxycodone hydrochloride (10.0 g, 28.5 mmol) was dissolved in chloroform(150 mL) and washed with 5% aq. NaHCO₃ (50 mL). The organic layer wasdried over MgSO₄ and evaporated. The residue was dried under vacuumovernight to provide oxycodone free base (8.3 g, 93%) as a white solid.

Preparation of Compound K

A solution of oxycodone free base (6.6 g, 21.0 mmol) in THF (400 mL) wascooled to −20° C., followed by addition of a 0.5 M solution of KHMDS intoluene (46.3 mL, 23.1 mmol). The obtained solution was then added to asolution of 4-nitro-phenyl chloroformate (4.3 g, 21.0 mmol) in THF (100mL) dropwise over the period of 20 min at −20° C. The reaction wasmaintained at −20° C. for an additional 1 h, followed by addition of asolution of Compound J (10.0 g, 16.1 mmol) in THF (200 mL) at −20° C.The reaction mixture was allowed to warm to ambient temperature andstirred overnight. Solvents were evaporated under vacuum. The resultingresidue was dissolved in EtOAc (20 mL) and precipitated with ether (1L). The formed precipitate was filtrated, washed with ether and driedunder vacuum to provide Compound K (13.6 g, 87%) as an off-white solid.LC-MS [M+H] 966.9 (C₄₈H₆₇N₇O₁₂S+H, calc: 966.2).

Synthesis ofN-1-[2-(oxycodone-6-enol-carbonyl-methyl-amino)-ethylamine]-L-arginine-malonate(Compound KC-3)

Compound K (13.6 g, 14.1 mmol) was dissolved in a mixture of 5%m-cresol/TFA (100 mL). The reaction mixture was maintained at ambienttemperature for 1 h, followed by dilution with ethyl ether (1 L). Theformed precipitate was filtered, washed with ether and hexane, and driedunder vacuum to provide a TFA salt of Compound KC-3 (11.4 g, 81%) as anoff-white solid. LC-MS [M+H] 658.6 (C₃₁H₄₃N₇O₉+H, calc: 658.7).

The TFA salt of crude Compound KC-3 (11.4 g, 11.4 mmol) was dissolved inwater (50 mL). The obtained solution was subjected to HPLC purification.[Nanosyn-Pack YMC-GEL-ODS A (100-10) C-18 column (75×500 mm); flow rate:250 mL/min; injection volume 50 mL; mobile phase A: 100% water, 0.1%TFA; mobile phase B: 100% ACN, 0.1% TFA; isocratic elution at 0% B in 4min, gradient elution from 0% to 10% B in 20 min, isocratic elution at10% B in 30 min, gradient elution from 10% B to 30% B in 41 min;detection at 254 nm]. Fractions containing Compound KC-3 were combinedand concentrated under vacuum. The TFA counterion of the latter wasreplaced with an HCl counterion via lyophilization using 0.1N HCl toprovide an HCl salt of Compound KC-3 (4.2 g, 41% yield) as a whitesolid. LC-MS [M+H]658.6 (C₃₁H₄₃N₇O₉+H, calc: 658.7).

Example 3 Synthesis ofN-(oxycodone-6-enol-carbonyl)piperidine-2-methylamine (Compound KC-11)andN-(oxycodone-6-enol-carbonyl)piperidine-2-methylamine-L-arginine-L-alanine-acetate(Compound KC-13)

Preparation of Oxycodone Free Base (L):

Oxycodone-hydrochloride (21.0 g, 59.7 mmol) was dissolved in water (250mL). This solution was basified with saturated aqueous NaHCO₃ (to pH8-9) and extracted with DCM (3×250 mL). The combined organic layer wasdried over Na₂SO₄ and filtered; removal of solvents under vacuumafforded Compound L in 98% yield (18.5 g, 58.8 mmol) as a white solid.LC-MS [M+H] 316.1 (C₁₈H₂₁NO₄+H, calc: 316.2). Compound L was useddirectly in the next reaction without further purification.

Preparation of Compound N

To a solution of Compound L (14.71 g, 46.7 mmol) in THF (250 mL) at −60°C. was added 0.5 M KHMDS solution in THF (103 mL) dropwise. Afterstirring at −60° C. for 30 min, the reaction mixture was added to asolution of 4-nitrophenyl chloroformate at −60° C. (9.41 g, 46.7 mmol)in THF (200 mL). This reaction mixture was then stirred for 30 min at−60° C., followed by addition of piperidine-2-yl-methylcarbamic acidtert-butyl ester, also referred to herein as(R,S)-piperidine-2-yl-methylcarbamic acid tert-butyl ester, (5.0 g, 23.3mmol) in portions. The reaction was allowed to warm to ambienttemperature and then stirred for 18 h. The reaction was thenconcentrated under vacuum, and the residue diluted with EtOAc (500 mL).The mixture was then washed with water (2×250 mL) and brine (250 mL).The organic layer was separated, dried over Na₂SO₄, and filtered.Removal of solvents under vacuum afforded crude Compound N. CrudeCompound N was purified by flash chromatography using 100% EtOAc.Removal of solvent under vacuum afforded Compound N in 50% yield (6.5 g,11.7 mmol) as a white solid. LC-MS [M+H] 556.1 (C₃₀H₄₁N₃O₇+H, calc:555.3).

Preparation of N-(oxycodone-6-enol-carbonyl)piperidine-2-methylamine)(KC-11)

A solution of Compound N (6.5 g, 11.7 mmol) in 1,4-dioxane (100 mL) wastreated with hydrogen chloride (4.0M solution in 1,4-dioxane, 100 mL).After 1 h, most of the 1,4-dioxane was removed under vacuum to −20 mLremaining. To this solution was added Et₂O (˜750 mL). The product wasthen precipitated as an HCl salt. The precipitate was filtered, washedwith ether and dried under vacuum to afford Compound KC-11 in 97% yield(5.96 g, 11.3 mmol) as a white solid. LC-MS [M+H] 456.3 (C₂₅H₃₃N₃O₅+H,calc: 456.2). Compound KC-11 was used directly in the next reactionwithout further purification.

Preparation of Compound O

To a solution of Boc-Arg(Pbf)-OH (5.94 g, 11.3 mmol), Compound KC-11(5.95 g, 11.3 mmol) and DIEA (8.24 mL, 47.4 mmol) in DMF (100 mL) at ˜0°C. was added HATU (4.28 g, 11.3 mmol) in portions over 10 min. Thetemperature of the reaction mixture was raised to ambient temperatureand stirring was continued for an additional 1 h. DMF was removed undervacuum, and the reaction mixture was diluted with EtOAc (300 mL), washedwith water (3×150 mL) and brine (150 mL). The organic layer wasseparated, dried over Na₂SO₄, and filtered. Removal of solvents undervacuum afforded crude Compound O. This compound was purified by silicagel chromatography using CHCl₃ and 0% to 20% MeOH. Removal of solventsunder vacuum afforded Compound O in 23% yield (2.5 g, 2.6 mmol) as afoamy solid. LC-MS [M+H]964.8 (C₄₉H₆₉N₇O₁₁S+H, calc: 964.5).

Preparation of Compound P

A solution of Compound O (2.5 g, 2.6 mmol) in 1,4-dioxane (50 mL) wastreated with hydrogen chloride (4.0 M solution in 1,4-dioxane, 50 mL).After 1 h, most of the 1,4-dioxane was removed under vacuum until ˜10 mLremained. To this solution was added Et₂O (˜500 mL). The productprecipitated as an HCl salt. The precipitate was filtered off, washedwith ether, and dried under vacuum to afford Compound P in 52% yield(1.25 g, 1.33 mmol) as a white solid. LC-MS [M+H] 864.6 (C₄₄H₆₁N₇O₉S+H,calc: 863.4). Compound P was used directly in the next reaction withoutfurther purification.

Preparation of Compound Q

To a solution of Boc-Ala-OH (0.13 g, 0.66 mmol), Compound P (0.62 g,0.66 mmol), and DIEA (0.48 mL, 2.77 mmol) in DMF (10 mL) at 5° C., wasadded HATU (0.25 g, 0.66 mmol) in portions over 5 min. The temperatureof the reaction mixture was raised to ambient temperature, and stirringwas continued for an additional 1 h. DMF was removed under vacuum. Nextthe reaction mixture was diluted with EtOAc (100 mL), and washed withwater (3×50 mL) and brine (50 mL). The organic layer was separated,dried over Na₂SO₄, and filtered. Removal of solvents under vacuumafforded crude Compound Q, yield exceeded quantitative, (0.69 g, 0.66mmol) as an off-white solid. LC-MS [M+H] 1035.6 (C₅₂H₇₄N₈O₁₂S+H, calc:1035.5). Compound Q was used directly in the next reaction withoutfurther purification.

Preparation of Compound R

A solution of Compound Q (0.69 g, 0.66 mmol) in 1,4-dioxane (10 mL) wastreated with hydrogen chloride (4.0 M solution in 1,4-dioxane, 10 mL).After 1 h, most of the 1,4-dioxane was removed under vacuum until ˜2 mLremained. To this solution was added Et₂O (˜100 mL). The productprecipitated as an HCl salt. The precipitate was washed with ether anddried under vacuum to afford crude Compound R, yield exceededquantitative, (0.67 g, 0.66 mmol) as an off-white solid. LC-MS [M+H]935.8 (C₄₇H₆₆N₈O₁₀S+H, calc: 935.5). Compound R was used directly in thenext reaction without further purification.

Preparation of Compound S

To a solution of Compound R (0.67 g, 0.66 mmol) and DIEA (0.37 mL, 2.1mmol) in CHCl₃ (50 mL) and cooled to ˜0° C., was added acetic anhydride(Ac₂O) (0.07 mL, 0.7 mmol). The reaction mixture was stirred at ambienttemperature for 30 min. The reaction mixture was diluted with CHCl₃ (50mL), and washed with water (2×100 mL) and brine (50 mL). The organiclayer was separated, dried over Na₂SO₄, and filtered. Removal ofsolvents under vacuum afforded the crude Compound S, yield exceededquantitative, (0.65 g, 0.66 mmol) as an off-white solid. LC-MS [M+H]977.4 (C₄₉H₆₈N₈O₁₁S+H, calc: 977.5). Compound S was used directly in thenext reaction without further purification.

Preparation ofN-(oxycodone-6-enol-carbonyl)piperidine-2-methylamine-L-arginine-L-alanine-acetate(Compound KC-13)

Compound S (0.65 g, 0.66 mmol) was treated with 5% m-cresol in TFA (15mL) for 1 h. The product was precipitated via addition of Et₂O (100 mL).The precipitate was washed with Et₂O (2×100 mL) and dried under vacuumto afford crude Compound KC-13. This product was dissolved in water (15mL), and the solution was subjected to HPLC purification. [Nanosyn-PackMicrosorb (100-10) C-18 column (50×300 mm); flow rate: 100 mL/min;injection volume 15 mL; mobile phase A: 100% water, 0.1% TFA; mobilephase B: 100% ACN, 0.1% TFA; isocratic elution at 0% B in 5 min,gradient elution from 0% to 20% B in 20 min, isocratic elution at 20% Bin 20 min, gradient elution from 20% B to 45% B in 40 min; detection at254 nm]. Fractions containing the desired compound were combined andconcentrated under vacuum. The residue was dissolved in ACN (˜2 mL) and0.1 N HCl (˜8 mL), and lyophilized overnight to provide the hydrochloricsalt of Compound KC-13 in 90% yield (0.65 g, 0.59 mmol, 93.1% purity) asa white solid. LC-MS [M+H] 725.8 (C₃₆H₅₂N₈O₈+H, calc: 725.4).

Example 4 Synthesis ofN-(oxycodone-6-enol-carbonyl)pyrrolidine-2-methylamine (Compound KC-9)

Compound KC-9 was prepared following the method described in Example 3to prepare N-(oxycodone-6-enol-carbonyl)piperidine-2-methylamine(Compound KC-11), but using pyrrolidine-2-yl-methylcarbamic acidtert-butyl ester instead of piperidine-2-yl-methylcarbamic acidtert-butyl ester. LC-MS [M+H] 442.1 (C₂₄H₃₁N₃O₅+H, calc: 442.3).

Example 5 Synthesis ofN-(oxycodone-6-enol-carbonyl)pyrrolidine-2-methylamine-L-arginine-malonate(Compound KC-10)

Compound KC-10 was prepared following the method described in Example 3to prepareN-(oxycodone-6-enol-carbonyl)piperidine-2-methylamine-L-arginine-L-alanine-acetate(Compound KC-13), but using pyrrolidine-2-yl-methylcarbamic acidtert-butyl ester instead of piperidine-2-yl-methylcarbamic acidtert-butyl ester, and using mono-tert-butyl malonate instead ofBoc-Ala-OH. LC-MS [M+H] 684.4 (C₃₃H₄₅N₇O₉+H, calc: 684.4).

Example 6 Synthesis ofN-(oxycodone-6-enol-carbonyl)piperidine-2-methylamine-L-arginine-malonate(Compound KC-12)

Compound KC-12 was prepared following the method described in Example 3to prepareN-(oxycodone-6-enol-carbonyl)piperidine-2-methylamine-L-arginine-L-alanine-acetate(Compound KC-13), but using mono-tert-butyl malonate instead ofBoc-Ala-OH. LC-MS [M+H] 698.4 (C₃₅H₄₇N₇O₉+H, calc: 698.7).

Example 7 Synthesis ofN-(oxycodone-6-enol-carbonyl)piperidine-2-methylamine-L-arginine-glycine-acetate(Compound KC-14)

Compound KC-14 was prepared following the method described in Example 3to prepareN-(oxycodone-6-enol-carbonyl)piperidine-2-methylamine-L-arginine-L-alanine-acetate(Compound KC-13), but using Boc-Gly-OH instead of Boc-Ala-OH. LC-MS[M+H] 711.3 (C₃₅H₅₀N₈O₈+H, calc: 711.4).

Example 8 Synthesis ofN-(oxycodone-6-enol-carbonyl)piperidine-2-methylamine-L-arginine-L-alanine-malonate(Compound KC-15)

Compound KC-15 was prepared following the method described in Example 3to prepareN-(oxycodone-6-enol-carbonyl)piperidine-2-methylamine-L-arginine-L-alanine-acetate(Compound KC-13), but using mono-tert-butyl malonate instead of aceticanhydride. LC-MS [M+H] 769.6 (C₃₇H₅₂N₈O₁₀+H, calc: 769.4).

Example 9 Synthesis ofN-(oxycodone-6-enol-carbonyl)piperidine-2-methylamine-L-arginine-glycine-malonate(Compound KC-16)

Compound KC-16 was prepared following the method described in Example 3to prepareN-(oxycodone-6-enol-carbonyl)piperidine-2-methylamine-L-arginine-L-alanine-acetate(Compound KC-13), but using Boc-Gly-OH instead of Boc-Ala-OH, and usingmono-tert-butyl malonate instead of acetic anhydride. LC-MS [M+H] 755.4(C₃₆H₅₀N₈O₁₀+H, calc: 755.4).

Example 10 Synthesis ofN-(oxycodone-6-enol-carbonyl)-R-(piperidine-2-methylamine)-L-arginine-glycine-malonate(Compound KC-17)

Compound KC-17 was prepared following the method described in Example 3to prepareN-(oxycodone-6-enol-carbonyl)piperidine-2-methylamine-L-arginine-L-alanine-acetate(Compound KC-13), but using (R)-piperidine-2-yl-methylcarbamic acidtert-butyl ester instead of (R,S)-piperidine-2-yl-methylcarbamic acidtert-butyl ester, using Boc-Gly-OH instead of Boc-Ala-OH, and usingmono-tert-butyl malonate instead of acetic anhydride. LC-MS [M+H] 755.5(C₃₆H₅₀N₈O₁₀+H, calc: 755.4).

Example 11 Synthesis ofN-(oxycodone-6-enol-carbonyl)-R-(piperidine-2-methylamine) (CompoundKC-18)

Compound KC-18 was prepared following the method described in Example 3to prepare N-(oxycodone-6-enol-carbonyl)piperidine-2-methylamine(Compound KC-11), but using (R)-piperidine-2-yl-methylcarbamic acidtert-butyl ester instead of (R,S)-piperidine-2-yl-methylcarbamic acidtert-butyl ester. LC-MS [M+H] 456.2 (C₂₅H₃₃N₃O₈+H, calc: 456.3).

Example 12 Synthesis ofN-(hydrocodone-6-enol-carbonyl)-R-(piperidine-2-methylamine)-L-arginine-glycine-malonate(Compound KC-31)

Compound KC-31 was prepared following the method described in Example 10to prepareN-(oxycodone-6-enol-carbonyl)-R-(piperidine-2-methylamine)-L-arginine-glycine-malonate(Compound KC-17), except hydrocodone was used instead of oxycodone.LC-MS [M+H] 739.6 (C₃₆H₅₀N₈O₉+H calc: 739.9).

Example 13 Synthesis ofN-(Tapentadol-carbonyl)piperidine-2-methylamine-L-arginine-malonate(Compound TP-5)

Preparation of Compound U

A solution of2-(tert-butoxycarbonylamino-methyl)-piperidine-1-carboxylic acid benzylester (Compound T) (3.0 g, 8.61 mmol) was treated with HCl (4.0 Msolution in 1,4-dioxane, 20 mL) for 1 h. The solvents were removed undervacuum until a volume of ˜10 mL remained, after which Et₂O (500 mL) wasadded. The precipitate was filtered off and washed with Et₂O (2×100 mL)and dried to afford crude Compound U in a quantitative yield (2.87 g,8.61 mmol) as a white solid. LC-MS [M+H] 249.3 (C₁₉H₂₈N₂O₄+H, calc:249.3). Compound U was used directly in the next reaction withoutfurther purification.

Preparation of Compound V

A solution of Boc-Arg(Pbf)-OH (4.54 g, 8.61 mmol), Compound U (2.87 g,8.61 mmol), and DIEA (3.9 mL, 22.4 mmol) in DMF (100 mL) was cooled to0° C. (in an ice bath); HATU (3.5 g, 8.61 mmol) was added in portionsover 15 min. The reaction mixture was raised to ambient temperature, andstirring was continued for an additional 2 h. DMF was then removed undervacuum, and the residue was diluted with EtOAc (500 mL) and extractedwith water (3×100 mL) and brine (100 mL). The organic layer was driedover Na₂SO₄ and filtered. The removal of the solvents under vacuumyielded the crude Compound V which was purified by flash chromatographyusing CHCl₃ and MeOH to afford Compound V in 45% yield (2.9 g, 3.83mmol) as a foamy solid. LC-MS [M+H] 757.6 (C₃₈H₅₆N₆O₈S+H, calc: 757.4).

Preparation of Compound W

A solution of Compound V (2.7 g, 3.57 mmol) in MeOH (100 mL) was treatedwith palladium (5 wt. % on activated carbon, 0.6 g) and subjected tohydrogenation at 70 psi for 1 h.

The reaction mixture was filtered using a Celite pad. The removal ofMeOH afforded Compound W in 99% yield (2.19 g, 3.51 mmol) as a foamysolid. LC-MS [M+H] 623.6 (C₃₀H₅₀N₆O₆S+H, calc: 623.4). Compound W wasused directly in the next reaction without further purification.

Preparation of Compound X

To a solution of tapentadol hydrochloride (0.5 g, 1.94 mmol) and DIEA(0.34 mL, 1.94 mmol) in CHCl₃ (15 mL) was added 4-nitrophenylchloroformate (0.38 g, 1.89 mmol), and the reaction mixture wassonicated for 30 min. To this reaction mixture was added Compound W(1.18 g, 1.89 mmol) in DMF (5 mL) at 5° C. The resultant reactionmixture was warmed to ambient temperature, and then allowed to stir for2 h. The solvents were then removed under vacuum, and the residue wasdiluted with EtOAc (100 mL), and washed with water (2×50 mL) and brine(25 mL). The organic layer was dried over Na₂SO₄ and filtered; theremoval of the solvents under vacuum afforded Compound X in quantitativeyield (1.7 g, 1.94 mmol) as an oil. LC-MS [M+H] 870.8 (C₄₅H₇₁N₇O₈S+H,calc: 870.5). Compound X was used directly in the next reaction withoutfurther purification.

Preparation of Compound Y

A solution of Compound X (1.7 g, 1.94 mmol) in 1,4-dioxane (10 mL) wastreated with HCl (4.0 M solution in 1,4-dioxane, 10 mL) for 30 min. Thesolvents were then removed until a volume of ˜5 mL was reached, afterwhich Et₂O was added (250 mL). The resulting precipitate was filteredoff, washed with Et₂O (2×75 mL), and dried to afford crude Compound Y.The crude compound was dissolved in water (15 mL), and the solution wassubjected to HPLC purification. [Nanosyn-Pack Microsorb (100-10) C-18column (50×300 mm); flow rate: 100 mL/min; injection volume 15 mL;mobile phase A: 100% water, 0.1% TFA; mobile phase B: 100% ACN, 0.1%TFA; isocratic elution at 0% B in 5 min, gradient elution from 0% to 30%B in 30 min, isocratic elution at 30% B in 20 min, gradient elution from30% B to 50% B in 40 min; detection at 254 nm]. Fractions containing thedesired product were combined and concentrated under vacuum. The residuewas dissolved in MeCN (˜2 mL) and 0.1 N HCl (˜8 mL) and lyophilizedovernight to provide Compound Y in 53% yield (0.84 g, 1.00 mmol) as afoamy solid. LC-MS [M+H] 770.4 (C₄₀H₆₃N₇O₆S+H, calc: 770.5).

Preparation of Compound Z

To a solution of Compound Y (0.75 g, 0.89 mmol), mono-tert-ButylMalonate (0.13 mL, 1.08 mmol), and DIEA (0.46 mL, 2.7 mmol) in DMF (15mL) at 5° C. was added BOP (0.39 g, 1.08 mmol) in portions. The reactionmixture was stirred at ambient temperature for 1 h. DMF was removedunder vacuum, and the residue was diluted with EtOAc (100 mL), andwashed with water (2×50 mL) and brine (25 mL). The organic layer wasdried over Na₂SO₄ and filtered; the removal of the solvents affordedCompound Z in quantitative yield (1.2 g, 0.89 mmol) as an oil. LC-MS[M+H] 912.8 (C₄₇H₇₃N₇O₉S+H, calc: 912.5). Compound Z was used directlyin the next reaction without further purification.

Preparation ofN-(Tapentadol-carbonyl)piperidine-2-methylamine-L-arginine-malonate(Compound TP-5)

A solution of Compound Z (1.2 g, 0.89 mmol) in TFA (10 mL) was treatedwith 5% m-cresol for 1 h. The product was precipitated via addition ofEt₂O (100 mL). The precipitate was washed with Et₂O (2×100 mL) and driedunder vacuum. The resultant product was dissolved in water (15 mL), andthe solution was subjected to HPLC purification. [Nanosyn-Pack Microsorb(100-10) C-18 column (50×300 mm); flow rate: 100 mL/min; injectionvolume 15 mL; mobile phase A: 100% water, 0.1% TFA; mobile phase B: 100%ACN, 0.1% TFA; gradient elution from 0% to 20% B in 30 min, isocraticelution at 20% B in 30 min, gradient elution from 20% B 10 to 45% B in35 min; detection at 254 nm]. Fractions containing the desired productwere combined and concentrated under vacuum. The residue was dissolvedin MeCN (˜2 mL) and 0.1 N HCl (˜8 mL) and lyophilized overnight toprovide Compound TP-5 in 88% yield (0.56 g, 0.79 mmol, 95.0% purity) asa foamy solid. LC-MS [M+H] 604.5 (C₃₀H₄₉N₇O₆+H, calc: 604.4).

Example 14 Synthesis ofN-(hydrocodone-6-enol-carbonyl)-R-(piperidine-2-methylamine)-L-arginine-L-alanine-malonate(Compound KC-35)

Compound KC-35 was prepared following the method described in Example 10to prepareN-(oxycodone-6-enol-carbonyl)-R-(piperidine-2-methylamine)-L-arginine-glycine-malonate(Compound KC-17), except using Boc-Ala-OH instead of Boc-Gly-OH andusing hydrocodone instead of oxycodone. LC-MS [M+H] 753.7 (C₃₇H₅₂N₈O₉+Hcalc: 753.9).

Example 15 Synthesis ofN-(hydrocodone-6-enol-carbonyl)-R-(piperidine-2-methylamine)-L-arginine-glycine-acetate(Compound KC-36)

Compound KC-36 was prepared following the method described in Example 10to prepareN-(oxycodone-6-enol-carbonyl)-R-(piperidine-2-methylamine)-L-arginine-glycine-malonate(Compound KC-17), except using acetic anhydride instead ofmono-tert-butyl malonate and using hydrocodone instead of oxycodone.LC-MS [M+H] 695.8 (C₃₅H₅₀N₈O₇+H calc: 695.8).

Example 16 Synthesis ofN-(hydrocodone-6-enol-carbonyl)-R-(piperidine-2-methylamine)-L-arginine-L-alanine-acetate(Compound KC-37)

Compound KC-37 was prepared following the method described in Example 10to prepareN-(oxycodone-6-enol-carbonyl)-R-(piperidine-2-methylamine)-L-arginine-glycine-malonate(Compound KC-17), except using acetic anhydride instead ofmono-tert-butyl malonate, using Boc-Ala-OH instead of Boc-Gly-OH andusing hydrocodone instead of oxycodone. LC-MS [M+H] 695.8 (C₃₆H₅₂N₈O₇+Hcalc: 695.8).

Example 17 Synthesis ofN-(hydrocodone-6-enol-carbonyl)-R-(piperidine-2-methylamine)-L-arginine-acetate(Compound KC-38)

Compound KC-38 was prepared following the method described in Example 10to prepareN-(oxycodone-6-enol-carbonyl)-R-(piperidine-2-methylamine)-L-arginine-glycine-malonate(Compound KC-17), except not employing Boc-Gly-OH, using aceticanhydride instead of mono-tert-butyl malonate, and using hydrocodoneinstead of oxycodone. LC-MS [M+H] 638.5 (C₃₃H₄₇N₇O₆+H calc: 638.7).

Example 18 Synthesis ofN-(hydrocodone-6-enol-carbonyl)-R-(piperidine-2-methylamine)-L-arginine-malonate(Compound KC-39)

Compound KC-39 was prepared following the method described in Example 10to prepareN-(oxycodone-6-enol-carbonyl)-R-(piperidine-2-methylamine)-L-arginine-glycine-malonate(Compound KC-17), except not employing Boc-Gly-OH and using hydrocodoneinstead of oxycodone. LC-MS [M+H] 682.7 (C₃₄H₄₇N₇O₈+H calc: 682.8).

Example 19 Synthesis ofN-(hydrocodone-6-enol-carbonyl)-N-[ethyl-(2-methylamino)piperazine-4-carboxylate]-L-arginine-glycine-acetate(Compound KC-42)

Compound KC-42 was prepared following the method described in Example 10to prepareN-(oxycodone-6-enol-carbonyl)-R-(piperidine-2-methylamine)-L-arginine-glycine-malonate(Compound KC-17), except employing ethyl3-((tert-butoxycarbonylamino)methyl)piperazine-1-carboxylate (compoundCC, see Example 20 for synthesis) instead ofpiperidine-2-yl-methylcarbamic acid tert-butyl ester, using aceticanhydride instead of mono-tert-butyl malonate, and using hydrocodoneinstead of oxycodone. LC-MS [M+H] 768.7 (C₃₇H₅₃N₉O₉+H calc: 768.9).

Example 20 Synthesis of Ethyl3-((tert-butoxycarbonylamino)methyl)piperazine-1-carboxylate (CompoundCC)

Synthesis of pyrazin-2-ylmethyl-carbamic acid tert-butyl ester (CompoundAA)

To a solution of 2-aminomethyl-pyrazine (5.0 g, 45.87 mmol) inisopropanol (50 ml) was added di-tert-butyl-pyrocarbonate (12.0 g, 55.84mmol); the mixture was stirred at ambient temperature for 2 h. Next, thesolvent was evaporated and the residue was dissolved in DCM (30 ml), andsubjected to silica gel purification (chloroform/methanol gradient0->30% in 100 min.). Fractions containing desired product were combinedand evaporated. Residue was dried under vacuum to provide Compound AA inquantitative yield (10.22 g, 99% purity) as amorphous solid. LC-MS:(m/z) observed (M+H⁺) 210.5 (C₁₀H₁₅N₃O₂+H calc: 210.3).

Synthesis of piperazin-2-ylmethyl-carbamic acid tert-butyl ester(Compound BB)

Compound AA (10.22 g, 45.87 mmol) was dissolved in methanol (350 ml)followed by the addition of 1,1,2-trichloroethane (9.39 ml, 100.91mmol), a suspension of palladium on activated carbon (10 wt. %, 488 mg)and platinum on activated carbon (10 wt. %, 897 mg) in water (20 ml).The mixture was subjected to hydrogen (70 psi) on a Parr apparatus atambient temperature for 3 h. The reaction mixture was then filteredthrough the pad of celite and the filtrate was separated and evaporated.The residue was re-dissolved in isopropanol and re-evaporated. Theresulting solid was dried under vacuum at ambient temperature overnightto provide the hydrochloric salt of Compound BB in quantitative yield(14.05 g, 99% purity) as off-white solid. LC-MS: (m/z) observed (M+H⁺)216.5 (C₁₀H₂₁N₃O₂+H calc: 216.3). The desired product was used directlywithout further purification.

Synthesis of Ethyl3-((tert-butoxycarbonylamino)methyl)piperazine-1-carboxylate (CompoundCC)

To a solution of Compound BB (7.00 g, 22.79 mmol) in EtOH (abs., 200 ml)was added diethyl pyrocarbonate (3.35 ml, 22.79 mmol) portionwise (330μl×10) over 5 min. The reaction was monitored via LC-MS until completeconsumption of the starting material. Upon completion, the formedprecipitate was filtered and discarded. The filtrate was evaporateduntil dryness and was then dried under vacuum to provide hydrochloricsalt of Compound CC in 94% yield (6.75 g, 99% purity) as an off-whitesolid. LC-MS: (m/z) observed (M+H⁺) 288.2 (C₁₃H₂₅N₃O₄+H calc: 288.4).

Example 21 Synthesis ofN-(hydrocodone-6-enol-carbonyl)-N-[ethyl-(2-methylamino)piperazine-4-carboxylate]-L-arginine-acetate(Compound KC-43)

Compound KC-43 was prepared following the method described in Example 10to prepareN-(oxycodone-6-enol-carbonyl)-R-(piperidine-2-methylamine)-L-arginine-glycine-malonate(Compound KC-17), except using ethyl3-((tert-butoxycarbonylamino)methyl)piperazine-1-carboxylate (CompoundCC, see Example 20 for synthesis) instead ofpiperidine-2-yl-methylcarbamic acid tert-butyl ester, not employingBoc-Gly-OH, using acetic anhydride instead of mono-tert-butyl malonate,and using hydrocodone instead of oxycodone. LC-MS [M+H] 711.7(C₃₅H₅₀N₈O₈+H calc: 711.8).

Example 22 Synthesis ofN-(hydrocodone-6-enol-carbonyl)-N-[ethyl-(2-methylamino)piperazine-4-carboxylate]-L-arginine-malonate(Compound KC-44)

Compound KC-44 was prepared following the method described in Example 10to prepareN-(oxycodone-6-enol-carbonyl)-R-(piperidine-2-methylamine)-L-arginine-glycine-malonate(Compound KC-17), except using ethyl3-((tert-butoxycarbonylamino)methyl)piperazine-1-carboxylate (compoundCC, see Example 20 for synthesis) instead ofpiperidine-2-yl-methylcarbamic acid tert-butyl ester, not employingBoc-Gly-OH, and using hydrocodone instead of oxycodone. LC-MS [M+H]755.5 (C₃₆H₅₀N₈O₁₀+H calc: 755.8).

Example 23 Synthesis ofN-(hydrocodone-6-enol-carbonyl)-N-[ethyl-(2-methylamino)piperazine-4-carboxylate]-L-arginine-glycine-malonate(Compound KC-45)

Compound KC-45 was prepared following the method described in Example 10to prepareN-(oxycodone-6-enol-carbonyl)-R-(piperidine-2-methylamine)-L-arginine-glycine-malonate(Compound KC-17), except using ethyl3-((tert-butoxycarbonylamino)methyl)piperazine-1-carboxylate (compoundCC, see Example 20 for synthesis) instead ofpiperidine-2-yl-methylcarbamic acid tert-butyl ester and usinghydrocodone instead of oxycodone. LC-MS [M+H] 812.8 (C₃₈H₅₃N₉O₁₁+H calc:812.9).

Example 24 Synthesis ofN-(hydrocodone-6-enol-carbonyl)-(2-methylamino)piperidine-4-carboxylate]-L-arginine-glycine-acetate(Compound KC-40)

Preparation of Compound DD

2-Bromo isonicotinic acid (20.2 g, 100 mmol) was dissolved in DMF (500mL) at ambient temperature. Cs₂CO₃ (32.6 g, 100 mmol) was added in oneportion, followed by MeI (6.3 mL, 100 mmol). The mixture was stirred atambient temperature for 15 h, followed by the addition of water (500mL). The mixture was extracted with EtOAc (500 mL). The organic layerwas washed with water (500 mL), brine (500 mL) and then dried overNa₂SO₄. The organic layer was then filtrated and concentrated to givecompound DD as a white solid in 80% yield (17.4 g, 80.5 mmol). LC-MS:[M+H] 217.0 (C₇H₆BrNO₂+H, calc: 216.1). Compound DD was used directlywithout further purification.

Preparation of Compound EE

Compound DD (17.4 g, 80.5 mmol) was dissolved in DMF (160 mL), followedby the addition of Zn(CN)₂ (5.7 g, 48.53 mmol) in one portion. Themixture was degassed using nitrogen and then Pd(PPh₃)₄ (4.7 g) wasadded. The mixture was degassed again and then heated in an oil bath(120° C.). After 2.5 h, the reaction was cooled to ambient temperatureand water (200 mL) was added. The mixture was stirred for 30 min andthen filtered through a frit. The solid collected was washed with water(2×100 mL) and then dried under vacuum to give compound EE in 84% yield(11.0 g, 67.9 mmol). LC-MS: [M+H] 163.2 (C₈H₆N₂O₂+H, calc: 162.1).Compound EE was used directly without further purification.

Preparation of Compound FF

Compound EE (20.0 g, 123.4 mmol) was dissolved in IPA (500 mL). Boc₂O(37.7 g, 172.8 mmol), Pd/5% on barium sulfate (6.0 g) and NEt₃ (35 mL,246.9 mmol) were added to the reaction mixture. The mixture washydrogenated at 55 psi for 4 h on a Parr hydrogenator. The mixture wasthen filtered through a celite pad and then the celite pad was washedwith MeOH (3×80 mL). The combined filtrate was then concentrated and theresidue was partitioned between EtOAc (300 mL) and water (100 mL). Theorganic layer was washed with 10% citric acid (50 mL) and brine (50 mL),followed by drying over Na₂SO₄. Next the mixture was filtered andconcentrated to afford compound FF in 86% yield (28.0 g, 106.8 mmol).LC-MS: [M+H] 267.4 (C₁₃H₁₈N₂O₄+H, calc: 266.5). Compound FF was useddirectly without further purification.

Preparation of Compound GG

To a solution of compound FF (1.50 g, 5.64 mmol) in MeOH (25 mL) wascarefully added, under nitrogen, 10% Pd/C (250 mg), 10% Pt/C (200 mg)and 1,1,2-trichloroethane (630 mL, 6.8 mmol, 1.2 eq). The reactionmixture was stirred at 65 psi overnight. Upon completion, the reactionmixture was filtered through a Celite-padded glass frit and washed withMeOH (3×20 mL). The filtrate was concentrated under vacuum to the volume˜10 mL and diethyl ether (100 mL) was added. The resulting fine whiteprecipitate was filtered, washed with ether (2×50 mL) and dried underhigh vacuum. The resulting HCl salt was dissolved with sonication inwater (30 mL) and aqueous 1 N NaOH solution (10 mL) was added. Thereaction mixture was extracted with DCM (3×25 mL). The organic phase wasdried over anhydrous Na₂SO₄, filtered, the solvent was evaporated undervacuum and the oily product was dried under high vacuum overnight. Thisafforded Compound GG (1.08 g, 72.5%). LC-MS: [M+H] 267.2 (C₁₃H₁₈N₂O₄+H,calc: 267.1). Retention time [Chromolith SpeedRod RP-18e C18 column(4.6×50 mm); flow rate: 1.5 mL/min; mobile phase A: 0.1% TFA/water;mobile phase B 0.1% TFA/ACN; gradient elution from 5% B to 100% B over9.6 min): 2.79 min.

Preparation of Compound HH

A solution of hydrocodone-free base (1.90 g, 6.35 mmol) in THF (50 mL)was cooled to −78° C. and then 0.5 M toluene solution of KHMDS (12.7 mL,6.35 mmol) was added dropwise over 5 min under nitrogen. The reactionmixture was stirred for 30 min, and then added to a solution of4-nitrophenyl chloroformate (1.35 g, 6.35 mmol) in THF (25 mL) dropwiseover 5 min under nitrogen and cooling with dry ice/acetone. Uponcompletion, 2 M HCl in diethyl ether (25 mL) and ether (100 mL) wasadded dropwise to the reaction mixture to produce a fine whiteprecipitate. The precipitate was filtered on a glass frit and washedwith ether (3×50 mL). The solid was dried under high vacuum overnight,then dissolved in 5% aq KH₂PO₄ solution (200 mL) and extracted with DCM(2×50 mL). The organic phase was dried over Na₂SO₄ (anh.), filtered, andthe solvent was concentrated under vacuum to the volume ˜10 mL. To themixture was added 2 M solution of HCl in diethyl ether (20 mL) and ether(100 mL). The resulting fine white precipitate was filtered off, washedwith ether (2×50 mL) and dried under high vacuum to afford compound HHin 66.1% yield (2.1 g, 4.20 mmol). LC-MS [M+H]: 465.3 (C₂₅H₂₄N₂O₇+H,calc: 464.2). Retention time [Chromolith SpeedRod RP-18e C18 column(4.6×50 mm); flow rate: 1.5 mL/min; mobile phase A: 0.1% TFA/water;mobile phase B 0.1% TFA/ACN; gradient elution from 5% B to 100% B over9.6 min, detection 254 nm]: 4.94 min.

Preparation of Compound II

Compound GG (6.0 g, 22.0 mmol) and compound HH (12.5 g, 24.0 mmol) weredissolved in DMF (40 mL) and DIEA (15.3 mL, 88 mmol) was added. Thereaction mixture was stirred at 40° C. for approximately 4 h, until allthe starting amine GG was consumed. Upon reaction completion, the DMFwas evaporated and the resulting oily product was dissolved in DCM (700mL). The mixture was then washed with 5% sodium phosphate (2×700 mL),0.1 N aq. HCl (500 mL) and brine (750 mL). The organic phase was driedover Na₂SO₄ (anhydrous), filtered and the solvent was evaporated. Theoily product was dried in high vacuum overnight to afford compound II in91.2% yield. (12.2 g, 20.1) LC-MS: [M+H] 578.6 (C₃₂H₄₃N₃O₈+H, calc:578.7). Retention time [Chromolith SpeedRod RP-18e C18 column (4.6×50mm); flow rate: 1.5 mL/min; mobile phase A: 0.1% TFA/water; mobile phaseB 0.1% TFA/ACN; gradient elution from 5% B to 100% B over 9.6 min,detection 254 nm): as 4 isomers, 5.90 min (A₁), 5.94 min (A₂), 6.47 min(B), 6.58 min (C).

Preparation of Compound JJ (Major Isomers)

A solution of compound II (12.2 g, 21.2 mmol) in DCM (100 mL) wastreated with 4 M solution of hydrogen chloride in 1,4-dioxane (50 mL).After 1 h, solvent was removed under vacuum until about ˜50 mL remained.Diethyl ether (˜500 mL) was added to the reaction mixture, whichproduced a fine white precipitate. The precipitate was filtered off,washed with ether (3×150 mL) and dried under vacuum to give the HCl saltof compound JJ as a fine white solid. The solid was dissolved in water(70 mL) and acetic acid (10 mL) and the solution was subjected to HPLCpurification, 5 runs: [Nanosyn-Pack Microsorb (100-10) C-18 column(50×300 mm); flow rate: 100 mL/min; injection volume: 4×5 mL; mobilephase A: 100% water, 0.1% TFA; mobile phase B: 100% acetonitrile, 0.1%TFA; gradient elution from 5% to 30% B in 60 min; detection at UV 254nm. Fractions containing the major isomers were combined andconcentrated under vacuum. The resulting oily residue was co-evaporatedwith isopropanol (3×100 mL). The oily product was treated with 2 M HClin ether (20 mL) and ether (400 mL) to produce a fine white precipitate.The precipitate was filtered off, washed with ether (2×50 mL) and driedunder high vacuum to afford the two major isomer of compound JJ in 69.2%yield (8.1 g, 14.7 mmol). LC-MS, [M+H] 498.4 (C₂₇H₃₅N₃O₆+H, calc:498.6). Retention time [Chromolith SpeedRod RP-18e C18 column (4.6×50mm); flow rate: 1.5 mL/min; mobile phase A: 0.1% TFA/water; mobile phaseB 0.1% TFA/ACN; gradient elution from 5% B to 100% B over 9.6 min,detection 254 nm]: as 2 isomers: 2.81 min (major-1), 2.96 min (major-2).

Preparation of Compound KK (Major Isomers)

To a solution of Boc-Arg(Pbf)-OH (18.96 g, 36.0 mmol), Compound JJ (19.6g, 34.3 mmol) and HATU (13.3 g, 37.7 mmol) in DMF (200 mL) at 5° C. wasadded DIEA (24.0 mL, 137 mmol) dropwise over 5 min. The temperature ofthe reaction mixture was raised to ambient temperature and stirring wascontinued for an additional hour. Upon reaction completion, DMF wasremoved under vacuum and the reaction mixture was then diluted with DCM(300 mL), washed with 2% aq. H₂SO₄ (500 mL), then with 5% sodiumphosphate (500 mL) and brine (750 mL). The organic phase was dried overNa₂SO₄ (anh.), filtered, and the solvent was evaporated under vacuum.The oily product was dried under high vacuum overnight to affordcompound KK as a foamy solid in 97.2% yield. (34.2 g, 33.3 mmol) LC-MS:[M+H] 1007.1 (C₅₁H₇₁N₇O₁₂S+H, calc: 1007.2). Retention time [ChromolithSpeedRod RP-18e C18 column (4.6×50 mm); flow rate: 1.5 mL/min; mobilephase A: 0.1% TFA/water; mobile phase B 0.1% TFA/ACN; gradient elutionfrom 5% B to 100% B over 9.6 min, detection 254 nm): 5.43 min.

Preparation of Compound LL (Major Isomers)

To a solution of compound KK (34.3 g, 34.0 mmol) in DCM (100 mL) wasadded 4.0 M solution of hydrogen chloride in 1,4-dioxane (150 mL). After1 h, the solvent was evaporated under vacuum to about 50 mL and to thereaction mixture was added diethyl ether (500 mL) to produce a finewhite precipitate. The precipitate was filtered off, washed with ether(3×150 mL) and dried under vacuum to give the HCl salt of compound LL in82.7% yield (23.9 g, 28.1 mmol) as a fine white solid. LC-MS, [M+H]906.6 (C₄₆H₆₃N₇O₁₀S+H, calc: 906.1). Retention time [Chromolith SpeedRodRP-18e C18 column (4.6×50 mm); flow rate: 1.5 mL/min; mobile phase A:0.1% TFA/water; mobile phase B 0.1% TFA/ACN; gradient elution from 5% Bto 100% B over 9.6 min, detection 254 nm]: 4.46 min.

Preparation of Compound MM (Major Isomers)

To a solution of HO-Gly-NAc (3.0 g, 25.5 mmol), Compound LL (23.4 g,24.3 mmol, 1 eq) and HATU (9.7 g, 25.5 mmol) in DMF (100 mL) at 5° C.was added DIEA (17 mL, 100 mmol) dropwise over 5 min. The temperature ofthe reaction mixture was raised to ambient temperature and stirring wascontinued for an additional hour. Upon reaction completion, DMF wasremoved in high vacuum, and the reaction mixture was diluted with DCM(300 mL), washed with 2% aq. H₂SO₄ (500 mL), then with 5% sodiumphosphate (500 mL) and brine (750 mL). The organic phase was dried overNa₂SO₄ (anh.), filtered and the solvent was evaporated. The oily productwas dried under high vacuum overnight to afford compound MM in 93.8%yield (22.9 g, 23.9 mmol) as a yellow oil. LC-MS: [M+H] 1005.7(CsoH₆₈N₈O₁₂S+H, calc: 1005.2). Retention time [Chromolith SpeedRodRP-18e C18 column (4.6×50 mm); flow rate: 1.5 mL/min; mobile phase A:0.1% TFA/water; mobile phase B 0.1% TFA/ACN; gradient elution from 5% Bto 100% B over 9.6 min, detection 254 nm): 4.75 min.

Preparation of Compound NN (Major Isomers)

To a solution of Compound MM (22.8 g, 22.9 mmol) in methanol (120 nL) at5° C. was added aqueous solution of LiOH (1.6 g, 70 mmol) in water (50mL). The temperature of the reaction mixture was raised to ambienttemperature and stirring was continued for an additional 2 h. Upon thereaction completion, the reaction mixture was neutralized with aceticacid to pH ˜4.0 and the methanol was evaporated under vacuum. Theresulted solution was subjected to prep HPLC purification. [Nanosyn-PackMicrosorb (100-10) C-18 column (50×300 mm); flow rate: 100 mL/min;injection volume: 4×5 mL; mobile phase A: 100% water, 0.1% TFA; mobilephase B: 100% acetonitrile, 0.1% TFA; gradient elution from 5% to 30% Bin 20 min; isocratic 30% B in 15 min, 30% to 65% in 25 min; detection atUV 254 nm. Fractions containing the pure product were combined andconcentrated under vacuum. The resulting oily residue was co-evaporatedwith toluene (3×100 mL). The oily product was dried under high vacuum togive compound NN in 54.9% yield (12.4 g, 12.6 mmol). LC-MS, [M+H] 991.7(C₄₉H₆₆N₈O₁₂S+H, calc: 991.5). Retention time [Chromolith SpeedRodRP-18e C18 column (4.6×50 mm); flow rate: 1.5 mL/min; mobile phase A:0.1% TFA/water; mobile phase B 0.1% TFA/ACN; gradient elution from 5% Bto 100% B over 9.6 min, detection 254 nm]: 4.59 min.

Preparation ofN-(hydrocodone-6-enol-carbonyl)-[(2-methylamino)piperidine-4-carboxylate]-L-arginine-glycine-acetate(Compound KC-40, Major Isomers)

Compound NN (7.9 g, 7.9 mmol) was dissolved in TFA (50 mL) and wasstirred for 1 h. Next the TFA was evaporated under vacuum and theresulting oily residue was dissolved in acetic acid/DCM (10 mL/10 mL)and treated with 2 M HCl/ether. The formed white precipitate wasfiltered off and washed with ether (2×50 mL). The solid was dissolved inwater (60 mL) and subjected to prep HPLC purification. [Nanosyn-PackMicrosorb (100-10) C-18 column (50×300 mm); flow rate: 100 mL/min;injection volume: 4×5 mL; mobile phase A: 100% water, 0.1% TFA; mobilephase B: 100% acetonitrile, 0.1% TFA; gradient elution from 5% to 30% Bin 60 min; detection at UV 210 nm. Fractions containing the desiredproduct were combined and concentrated under vacuum. The resulting oilyresidue was co-evaporated with toluene (3×100 mL). The oily product wasdried under high vacuum to give a solid. The resulting solid wasdissolved in 0.1 M HCl (50 mL) and lyophilized to give Compound KC-40 in61.9% yield (3.2 g, 4.9 mmol). LC-MS, [M+H] 739.7 (C₃₆H₅₀N₈O₉+H, calc:739.4). Retention time [Chromolith SpeedRod RP-18e C18 column (4.6×50mm); flow rate: 1.5 mL/min; mobile phase A: 0.1% TFA/water; mobile phaseB 0.1% TFA/ACN; gradient elution from 5% B to 100% B over 9.6 min,detection 210 nm]: 3.11 min.

Example 25N-(hydrocodone-6-enol-carbonyl)-[(2-methylamino)piperidine-3-carboxylate]-L-arginine-glycine-acetate(Compound KC-32)

Compound KC-32 was prepared following the method described in Example 24to prepareN-(hydrocodone-6-enol-carbonyl)-(2-methylamino)piperidine-3-carboxylate]-L-arginine-glycine-acetate(Compound KC-40), except using methyl 6-bromonicotinate instead ofmethyl 2-bromoisomicothinate. LC-MS [M+H] 739.9 (C₃₆H₅₀N₈O₉+H calc:739.8).

Example 26 N-(hydrocodone-6-enol-carbonyl)-[(2-methylamino)-methylpiperidine-4-carboxylate]-L-arginine-glycine-acetate (Compound KC-41)

Compound KC-41 was prepared following the method described in Example 24to prepareN-(hydrocodone-6-enol-carbonyl)-(2-methylamino)piperidine-3-carboxylate]-L-arginine-glycine-acetate(Compound KC-40), except not employing LiOH (for methyl esterhydrolysis). LC-MS [M+H] 753.7 (C₃₇H₅₂N₈O₉+H calc: 753.9).

Example 27 N-(hydrocodone-6-enol-carbonyl)-[(2-methylamino)-N,N-dimethylpiperidine-4-carboxamide]-L-arginine-glycine-acetate (Compound KC-46)

Compound KC-46 was prepared following the method described in Example 24to prepareN-(hydrocodone-6-enol-carbonyl)-(2-methylamino)piperidine-3-carboxylate]-L-arginine-glycine-acetate(Compound KC-40), except conducting a amide bond coupling of KC-40 withdimethyl amine using standard HATU coupling procedures (see synthesis ofCompound O for a representative example). LC-MS [M+H] 766.6(C₃₈H₅₅N₉O₈+H calc: 766.9).

Example 28N-(hydrocodone-6-enol-carbonyl)-[(2-methylamino)-piperidine-4-carboxylate]-L-arginine-glycine-malonate(Compound KC-47)

Compound KC-47 was prepared following the method described in Example 24to prepareN-(hydrocodone-6-enol-carbonyl)-(2-methylamino)piperidine-3-carboxylate]-L-arginine-glycine-acetate(Compound KC-40), except employing Boc-Gly-OH instead of NAc-Gly-OH,followed by Boc removal and coupling with mono-tert-butyl malonate (Seesynthetic procedures for the synthesis of compound KC-13 forrepresentative examples of these synthetic transformations) LC-MS [M+H]783.7 (C₃₇H₅₀N₈O₁₁+H calc: 783.8).

Example 29N-(hydrocodone-6-enol-carbonyl)-[(2-methylamino)-piperidine-4-carboxylate]-L-arginine-malonate(Compound KC-48)

Compound KC-48 was prepared following the method described in Example 24to prepareN-(hydrocodone-6-enol-carbonyl)-(2-methylamino)piperidine-3-carboxylate]-L-arginine-glycine-acetate(Compound KC-40), except employing mono-tert-butyl malonate instead ofNAc-Gly-OH. LC-MS [M+H] 726.7 (C₃₅H₄₇N₇O₁₀+H calc: 726.8).

Example 30N-(hydrocodone-6-enol-carbonyl)-[(2-methylamino)-piperidine-4-carboxylate]-L-arginine-acetate(Compound KC-49)

Compound KC-49 was prepared following the method described in Example 24to prepareN-(hydrocodone-6-enol-carbonyl)-(2-methylamino)piperidine-3-carboxylate]-L-arginine-glycine-acetate(Compound KC-40), except employing acetic anhydride instead ofNAc-Gly-OH (see preparation of Compound S for representative syntheticexample of the use of acetic anhydride). LC-MS [M+H] 682.6 (C₃₇H₄₇N₇O₈+Hcalc: 682.8).

Example 31N-(hydrocodone-6-enol-carbonyl)-[(2-methylamino)-piperidine-4-carboxylate]-L-lysine-glycine-acetate(Compound KC-50)

Compound KC-50 was prepared following the method described in Example 24to prepareN-(hydrocodone-6-enol-carbonyl)-(2-methylamino)piperidine-3-carboxylate]-L-arginine-glycine-acetate(Compound KC-40), except employing Fmoc-Lys(Boc)-OH instead ofBoc-Arg(Pbf)-OH (see Greene and Wuts for examples of Fmoc removal).LC-MS [M+H] 711.7 (C₃₆H₅₀N₆O₉+H calc: 711.8).

Example 32N-(hydrocodone-6-enol-carbonyl)-[(2-methylamino)-piperidine-4-carboxylate]-L-lysine-acetate(Compound KC-51)

Compound KC-51 was prepared following the method described in Example 24to prepareN-(hydrocodone-6-enol-carbonyl)-(2-methylamino)piperidine-3-carboxylate]-L-arginine-glycine-acetate(Compound KC-40), except employing Fmoc-Lys(Boc)-OH instead ofBoc-Arg(Pbf)-OH (see Greene and Wuts for examples of Fmoc and also seeCompound S for representative synthetic example of the use of aceticanhydride). LC-MS [M+H] 711.7 (C₃₄H₄₇N₅O₈+H calc: 711.8).

Example 33N-(hydrocodone-6-enol-carbonyl)-[(2-methylamino)-piperidine-4-carboxylate]-L-lysine-malonate(Compound KC-52)

Compound KC-52 was prepared following the method described in Example 24to prepareN-(hydrocodone-6-enol-carbonyl)-(2-methylamino)piperidine-3-carboxylate]-L-arginine-glycine-acetate(Compound KC-40), except employing Fmoc-Lys(Boc)-OH instead ofBoc-Arg(Pbf)-OH (see Greene and Wuts for examples of Fmoc removal) andemploying mono-tert-butyl malonate instead of NAc-Gly-OH. LC-MS [M+H]698.5 (C₃₅H₄₇N₅O₁₀+H calc: 698.8).

Example 34N-(hydrocodone-6-enol-carbonyl)-[(2-methylamino)-piperidine-4-carboxylate]-L-lysine-glycine-malonate(Compound KC-53)

Compound KC-53 was prepared following the method described in Example 24to prepareN-(hydrocodone-6-enol-carbonyl)-(2-methylamino)piperidine-3-carboxylate]-L-arginine-glycine-acetate(Compound KC-40), except employing Fmoc-Lys(Boc)-OH instead ofBoc-Arg(Pbf)-OH (see Greene and Wuts for examples of Fmoc removal),Boc-Gly-OH instead of NAc-Gly-OH, followed by Boc removal and couplingwith mono-tert-butyl malonate (See synthetic procedures for thesynthesis of compound KC-13 for representative examples of thesesynthetic transformations). LC-MS [M+H] 755.5 (C₃₇H₅₀N₆O₁₁+H calc:755.8.8).

Example 35N-(oxycodone-6-enol-carbonyl)-[(2-methylamino)-piperidine-4-carboxylate]-L-arginine-glycine-acetate(Compound KC-55)

Compound KC-55 was prepared following the method described in Example 24to prepareN-(hydrocodone-6-enol-carbonyl)-(2-methylamino)piperidine-3-carboxylate]-L-arginine-glycine-acetate(Compound KC-40), except employing oxycodone instead of hydrocodone.LC-MS [M+H] 755.6 (C₃₆H₅₀N₈O₁₀+H calc: 755.8).

Example 36 Pharmacokinetics Following PO Administration ofKetone-Modified Opioid Prodrugs to Rats

This Example demonstrates the release of opioid into plasma whenketone-modified opioid prodrugs of the embodiments were administeredorally (PO) to rats.

Saline solutions of Compound KC-9, Compound KC-11, Compound KC-12,Compound KC-13, Compound KC-14, Compound KC-15, Compound KC-16, CompoundKC-17 (each of which can be prepared as described in the examplesherein) or oxycodone were dosed as indicated in Table 1 via oral gavageinto jugular vein-cannulated male Sprague Dawley rats (4 per group,except for the Compound KC-16 group which consisted of 3 rats) that hadbeen fasted for 16-18 h prior to oral dosing. At specified time points,blood samples were drawn, harvested for plasma via centrifugation at5,400 rpm at 4° C. for 5 min, and 100 microliters (μl) plasmatransferred from each sample into a fresh tube containing 2 μl of 50%formic acid. The tubes were vortexed for 5-10 seconds, immediatelyplaced in dry ice, and then stored in a −80° C. freezer until analysisby HPLC/MS.

Table 1 and FIG. 4 provide oxycodone exposure results for ratsadministered the indicated compounds. Results in Table 1 are reported,for each group of rats, as (a) maximum plasma concentration value (Cmax)of oxycodone (OC) (average±standard deviation), (b) time afteradministration of compound to reach maximum oxycodone concentrationvalue (Tmax) (average±standard deviation) and (c) area under the curvevalue (AUC) from 0 to 24 h (average±standard deviation).

TABLE 1 Cmax, Tmax and AUC values of oxycodone in rat plasma Dose, DoseOC Cmax ± AUC ± sd, Compound mg/kg μmol/kg sd, ng/mL Tmax ± sd, hng*h/mL KC-9 16 31 2.35 ± 2.3* 1.50 ± 0.58 4.63 ± 3.1 KC-11 18 34 13.6 ±3.0* 1.00 ± 0.0  57.0 ± 9.0 KC-12 22 29 9.99 ± 6.3* 1.25 ± 0.50 31.4 ±13  KC-13 23 29 13.5 ± 3.5{circumflex over ( )} 1.50 ± 0.58 40.6 ± 17 KC-14 23 29 7.06 ± 2.2* 1.25 ± 0.50 23.3 ± 4.9 KC-15 24 29 9.02 ± 2.5*1.50 ± 1.0  31.8 ± 9.2 KC-16 24 29 12.4 ± 4.2* 1.67 ± 0.58 54.7 ± 6.1KC-17 23 28 17.7 ± 3.8{circumflex over ( )} 1.00 ± 0.0  42.2 ± 9.7Oxycodone 10 28 14.7 ± 6.5^(#) 0.625 ± 0.43  71.2 ± 5.3 ^(#)Lower limitof quantitation was 0.0250 ng/mL {circumflex over ( )}Lower limit ofquantitation was 0.0500 ng/mL *Lower limit of quantitation was 0.100ng/mL

FIG. 4 compares mean plasma concentrations over time of oxycodonerelease following PO administration of oxycodone prodrugs of theembodiments to rats.

The results in Table 1 and FIG. 4 indicate that oral administration ofeach of the tested prodrugs to rats leads to release of oxycodone.Compound KC-11, Compound KC-12, Compound KC-13, Compound KC-14, CompoundKC-15, Compound KC-16, and Compound KC-17 effect release ofsignificantly more oxycodone than does Compound KC-9.

Example 37 Pharmacokinetics of Ketone-Modified Opioid Prodrugs FollowingPO Administration to Dogs

This Example demonstrates the release of oxycodone into plasma whenketone-modified oxycodone prodrugs of the embodiments were administeredorally (PO) to dogs. This Example also compares such release to that ofCompound KC-3, an oxycodone prodrug that, unlike the prodrugs of theseembodiments, lacks a heterocyclic ring in its cyclizable spacer leavinggroup. Also compared are oxycodone plasma levels in dogs administeredoxycodone or OxyContin® tablets.

Purebred male young adult/adult beagles were fasted overnight. Solutionsin water of Compound KC-3, Compound KC-12, Compound KC-13, CompoundKC-14, Compound KC-15, Compound KC-16, Compound KC-17 (each of which canbe prepared as described in the examples herein) or 2 mg/kg oxycodone(Johnson Matthey Pharmaceutical Materials, West Deptford, N.J., USA)were administered via oral gavage to the dogs (4 per group), asindicated in Table 2. One additional group of 4 dogs was administeredone 20-mg OxyContin® (oxycodone HCl) Controlled-Release C-II Tablet (NDC59011-420-10, Purdue Pharma, Stamford, Conn., USA). The tablet dose wasfollowed by approximately 5 mL of water to facilitate swallowing.

The doses were selected to provide approximately equimole amounts. Bloodwas collected from each animal via a jugular vein at various times overa 24-h period, centrifuged, and 0.8 mL plasma transferred to a freshtube containing 8 μL formic acid; samples were vortexed, thenimmediately placed in dry ice, and stored in a −80° C. freezer untilanalysis by HPLC/MS. Table 2, FIG. 5A and FIG. 5B provide oxycodoneexposure results for dogs administered the indicated compounds. Theoxycodone Cmax, Tmax and AUC values in Table 2 are reported, for eachgroup of four dogs, as described in Example 36.

TABLE 2 Cmax, Tmax and AUC values of oxycodone in dog plasma Dose, Dose,μmol/ OC Cmax ± Tmax ± AUC ± sd Compound mg/kg kg sd, ng/mL sd, h (ng ×h)/mL KC-3 4.15 5.7 10.2 ± 3.3^(#)   4.00 ± 65.6 ± 22   0.00 KC-12 4.385.7 75.0 ± 9.3{circumflex over ( )}  0.875 ± 272 ± 43  0.25 KC-13 4.535.7 57.4 ± 8.5{circumflex over ( )}  0.875 ± 221 ± 30  0.25 KC-14 4.465.7 74.7 ± 6.2^(#)   1.00 ± 275 ± 25  0.0  KC-15 4.78 5.7 93.7 ± 8.1* 0.625 ± 292 ± 25  0.25 KC-16 4.78 5.8 95.3 ± 10*   1.13 ± 391 ± 46  0.63KC-17 4.78 5.8 120 ± 38{circumflex over ( )}  0.750 ± 421 ± 62  0.29Oxycodone 2 5.7 193 ± 69^(#)  0.500 ± 418 ± 54  0.0  OxyContin  ® 20 mg64.7 ± 8.8^(#)   2.75 ± 329 ± 160 tablet 0.96 ^(#)Lower limit ofquantitation was 0.0250 ng/mL {circumflex over ( )}Lower limit ofquantitation was 0.0500 ng/mL *Lower limit of quantitation was 0.100ng/mL

FIG. 5A compares mean plasma concentrations over time of oxycodonefollowing PO administration of Compound KC-12, Compound KC-13, CompoundKC-14, Compound KC-15, Compound KC-16, Compound KC-17, OxyContin®tablets or oxycodone to dogs. FIG. 5B compares mean plasmaconcentrations over time of oxycodone following PO administration ofCompound KC-17, Compound KC-3, OxyContin® tablets or oxycodone to dogs.

The results in Table 2, FIG. 5A, and FIG. 5B indicate that prodrugcompounds of the embodiments administered orally to dogs effectefficient release of oxycodone into dog plasma. The results alsodemonstrate that compounds of the embodiments effect higher oxycodoneCmax values and faster oxycodone Tmax values in dog plasma than doesCompound KC-3, an oxycodone prodrug with an ethylene diamine cyclizablespacer leaving group.

Example 38 Pharmacokinetics of Ketone-Modified Opioid Prodrugs FollowingPO Administration of Increasing Amounts of Such Prodrugs to Rats

This Example demonstrates the release of opioid into plasma whenketone-modified opioid prodrugs of the embodiments were administeredorally (PO) to rats.

Saline solutions of Compound KC-12 or Compound KC-17 (each of which canbe prepared as described in the examples herein) were dosed as indicatedin Table 3 via oral gavage into jugular vein-cannulated male SpragueDawley rats (4 per group) that had been fasted for 16-18 h prior to oraldosing. At specified time points, blood samples were collected, treated,and analyzed in a manner similar to that described in Example 36.

TABLE 3 Dosing of Compound KC-12 and Compound KC-17 PO to rats. CompoundDose, mg/kg Dose, μmol/kg Compound KC-12 5 6.5 Compound KC-12 22 29Compound KC-17 5 6.0 Compound KC-17 23 28 Compound KC-17 50 60

FIG. 6A compares mean plasma concentrations over time of oxycodonerelease following PO administration of increasing doses of CompoundKC-12 to rats.

FIG. 6B compares mean plasma concentrations over time of oxycodonerelease following PO administration of increasing doses of CompoundKC-17 to rats.

The results in Table 3, FIG. 6A, and FIG. 6B indicate that plasmaconcentrations of oxycodone increase proportionally with dose ofprodrugs of the embodiments administered to rats.

Example 39 In Vitro Trypsin-Mediated Prodrug Cleavage and Spacer LeavingGroup Cyclization Rate of Ketone-Modified Opioid Prodrugs

This Example assesses the ability of trypsin to cleave ketone-modifiedopioid prodrugs of the embodiments. This Example also assesses the ratesof cyclization and release of oxycodone by compounds that lack thetrypsin-cleavable moiety but retain oxycodone attached to the respectivecyclizable spacer leaving group.

Compound KC-10, Compound KC-12, Compound KC-13, Compound KC-14, CompoundKC-15, Compound KC-16, and Compound KC-17 (each of which can be preparedas described in the examples herein) were each incubated with trypsinfrom bovine pancreas (Catalog No. T8003, Type I, ˜10,000 BAEE units/mgprotein, Sigma-Aldrich, St. Louis, Mo., USA). Specifically, thereactions included 0.761 mM of the respective prodrug, 22.5 mM calciumchloride, 40 to 172 mM Tris pH 8 and 0.25% DMSO with trypsinpreparations of varying activities. The reactions were conducted at 37°C. for 24 h. Samples were collected at specified time points,transferred into 0.5% formic acid in acetonitrile to stop trypsinactivity, and stored at less than −70° C. until analysis by LC-MS/MS.

Clock cyclization release rates were measured by following the rate ofdisappearance of Compound KC-9, Compound KC-11, and Compound KC-18 (2.18mM initial concentration) in a 50 mM pH 7.4 phosphate buffer at 20° C.

Table 4 indicates the results of exposure of the tested prodrugs totrypsin. The results are expressed as half-life of prodrug when exposedto trypsin (i.e., Prodrug trypsin half-life) in hours, and rate ofoxycodone formation in tmoles per hour per BAEE unit (tmol/h/BAEE U)trypsin. Table 4 also indicates the cyclization rate of the cyclizablespacer leaving group of Compound KC-9, Compound KC-11, and CompoundKC-18. The results are expressed as half-life of compound disappearance.For Compound KC-11, a diastereomer, two peaks (A and B) were analyzed.

TABLE 4 In vitro trypsin cleavage of prodrugs, and cyclization rates ofrespective cyclizable spacer leaving groups Prodrug trypsin OC formationrate, Com- Prodrug half-life, h * μmol/h/BAEE U pound half-life, h KC-10 0.1502 ±  0.00274 ± 0.000270 KC-9  714.4 ± 3.76  0.0051   KC-12  0.1583±  0.231 ± 0.0097 KC-11  1.30 ± 0.038 0.00019  peak A KC-11 0.876 ±0.012 peak B KC-13 0.000763 ± 47.1 ± 5.72 KC-11 ″ 0.0000085 peak A KC-11peak B KC-14 0.008572 ± 5.48 ± 0.1  KC-11 ″ 0.000033  peak A KC-11 peakB KC-15 0.002876 ± 22.3 ± 0.8  KC-11 ″ 0.00019  peak A KC-11 peak BKC-16  0.0395 ±  1.46 ± 0.093 KC-11 ″ 0.0027   peak A KC-11 peak B KC-17 0.0441 ±  1.23 ± 0.011 KC-18 0.875 ± 0.016 0.00195  * Adjusted to 4815BAEE U trypsin/mL

The results in Table 4 indicate that prodrugs of the embodiments can becleaved by trypsin, and that the respective spacer leaving groups cancyclize in a relatively rapid rate.

Example 40 Oral Administration of Ketone-Modified Opioid ProdrugsCo-Dosed with a Trypsin Inhibitor to Rats

This Example demonstrates the ability of a trypsin inhibitor to affectthe ability of ketone-modified opioid prodrugs of the embodiments torelease opioid into plasma when such ketone-modified opioid prodrugswere co-administered with such a trypsin inhibitor orally to rats.

Saline solutions of prodrug Compound KC-12 or prodrug Compound KC-17(each of which can be prepared as described in the examples herein) wereco-dosed with increasing concentrations of Compound 109 (Catalog No.3081, Tocris Bioscience, Ellisville, Mo., USA or Catalog No. WS38665,Waterstone Technology, Carmel, Ind., USA) as indicated in Table 5A andTable 5B respectively, to rats, using a method similar to that describedin Example 36. Sampling and analysis procedures were also similar tothose described in Example 36.

Table 5A and FIG. 7A provide oxycodone exposure results for ratsadministered 5 mg/kg (6.5 μmol/kg) of Compound KC-12 co-dosed withincreasing amounts of trypsin inhibitor Compound 109. The oxycodoneCmax, Tmax, and AUC values in Table 5A are reported, for each group offour rats, as described in Example 36.

TABLE 5A Cmax, Tmax and AUC values of oxycodone in rat plasma KC- 12KC-12 Compound Compound Dose, Dose, 109 Dose, 109 Dose, OC Cmax ± AUC ±sd, mg/kg μmol/kg mg/kg μmol/kg sd, ng/mL Tmax ± sd, h ng * h/mL 5 6.5 00 4.67 ± 1.7 1.25 ± 0.50  7.32 ± 0.97 5 6.5 0.1 0.2 3.86 ± 1.7 1.50 ±0.58 7.82 ± 1.6 5 6.5 0.5 0.9 3.71 ± 1.9 2.50 ± 0.58 9.60 ± 5.0 5 6.51.0 1.9  2.30 ± 0.48 2.50 ± 0.58 7.57 ± 1.5 Lower limit of quantitationwas 0.500 ng/mL

Table 5B, FIG. 7B and FIG. 7C provide oxycodone exposure results forrats administered 5 mg/kg (6 μmol/kg) or 50 mg/kg (60 μmol/kg) doses ofCompound KC-17, each co-dosed with increasing amounts of trypsininhibitor Compound 109. The oxycodone Cmax, Tmax, and AUC values inTable 5B are reported, for each group of four rats, as described inExample 36.

TABLE 5B Cmax, Tmax and AUC values of oxycodone in rat plasma KC- 17KC-17 Compound Compound Dose, Dose, 109 Dose, 109 Dose, OC Cmax ± AUC ±sd, mg/kg μmol/kg mg/kg μmol/kg sd, ng/mL Tmax ± sd, h ng * h/mL 5 6 0 02.35 ± 0.33{circumflex over ( )} 1.25 ± 0.50 7.16 ± 1.6 5 6 0.1 0.2 2.03± 0.85{circumflex over ( )} 1.50 ± 0.58 6.99 ± 2.8 5 6 0.5 0.9 3.85 ±1.1{circumflex over ( )} 1.75 ± 0.50 10.2 ± 2.0 5 6 1.0 1.9 2.18 ±0.38{circumflex over ( )} 2.00 ± 0.0  6.36 ± 1.3 50 60 0 0 40.1 ± 10*1.25 ± 0.50 127 ± 15 50 60 1 1.9 32.4 ± 11* 3.50 ± 3.0   201 ± 190 50 605 9.3 21.0 ± 9.0* 4.50 ± 1.0  117 ± 25 50 60 10 18.5 23.2 ± 3.0* 4.50 ±1.0  145 ± 54 {circumflex over ( )}Lower limit of quantitation was 0.100ng/mL *Lower limit of quantitation was 0.500 ng/mL

FIG. 7A compares mean plasma concentrations over time of oxycodonerelease following PO administration of 5 mg/kg (6.5 μmol/kg) of prodrugCompound KC-12 with increasing amounts of co-dosed trypsin inhibitorCompound 109 to rats.

FIG. 7B and FIG. 7C compare the mean plasma concentrations over time ofoxycodone release following PO administration of 5 mg/kg (6 μmol/kg) andof 50 mg/kg (60 μmol/kg) dose of prodrug Compound KC-17 with increasingamounts of co-dosed trypsin inhibitor Compound 109 to rats.

The results in Table 5A, Table 5B, FIG. 7A, FIG. 7B and FIG. 7C indicateCompound 109's ability to attenuate release of oxycodone by prodrugs ofthe embodiments.

Example 41 Effect of Trypsin Inhibition on In Vitro Trypsin-MediatedRelease of Opioid from a Phenolic Opioid Prodrug

This Example demonstrates the ability of trypsin to cleave a phenolicopioid prodrug of the embodiments. This Example further demonstrates theeffect of a trypsin inhibitor of the embodiments on such in vitrotrypsin-mediated release.

Tapentadol prodrug Compound TP-5 (which can be prepared as described inthe Examples herein) was incubated with trypsin from bovine pancreas(Catalog No. T8003, Type I, ˜10,000 BAEE units/mg protein,Sigma-Aldrich), in the absence or presence of Compound 109 (Catalog No.3081, Tocris Bioscience or Catalog No. WS38665, Waterstone Technology),as shown in Table 6. When Compound 109 was part of the reaction mixture,Compound TP-5 was added 5 min after the other incubation components.Other reaction, incubation, sample treatment and analysis procedureswere similar to those described in Example 39.

Table 6 indicates the results of exposure of Compound TP-5 to trypsin inthe absence or presence of trypsin inhibitor. The results are expressedas half-life of prodrug when exposed to trypsin (i.e., Prodrug trypsinhalf-life) in hours and rate of tapentadol (TP) formation in mol/h/BAEEU trypsin.

TABLE 6 In vitro trypsin conversion of Compound TP-5 to tapentadol andinhibition thereof by Compound 109 Pro-drug trypsin Rate of TPformation, Compound half-life, h * μmol/h/BAEE U Compound 109, μMAverage ± sd Average ± sd TP-5 0  0.0665 ± 0.000004 0.684 ± 0.036 TP-5 8  1.04 ± 0.00061 0.1043 ± 0.0049 * Adjusted to 4815 BAEE U/mL trypsin

The results in Table 6 indicate that trypsin can effect release oftapentadol from a phenolic opioid prodrug of the embodiments, and that atrypsin inhibitor of the embodiments can attenuate such release.

Example 42 Oral Administration of a Phenolic Opioid Prodrug Co-Dosedwith a Trypsin Inhibitor to Rats

This Example demonstrates the ability of a trypsin inhibitor of theembodiments to affect the ability of a phenolic opioid prodrug of theembodiments to release such opioid into plasma when such prodrug isadministered orally to rats.

Saline solutions of tapentadol prodrug Compound TP-5 (which can beprepared as described in the examples herein) were administered to ratseither without or with trypsin inhibitor Compound 109 as indicated inTable 7. Dosing, blood sampling and analysis procedures were similar tothose described in Example 40.

Table 7 and FIG. 8 provide tapentadol exposure results for ratsadministered Compound TP-5 in the absence or presence of trypsininhibitor Compound 109. The tapentadol Cmax, Tmax, and AUC values inTable 7 are reported for each group of four rats, as described inExample 36.

TABLE 7 Cmax, Tmax and AUC values of tapentadol in rat plasma CompoundCompound Dosing mg/kg 109 Dose, 109 Dose, TP Cmax ± sd, Tmax ± AUC ± sd[μmol/kg] mg/kg μmol/kg ng/mL sd, h (ng × h)/mL TP-5 23 [34] 0 0 1.90 ±0.35 2.50 ± 0.58 12.0 ± 1.30 TP-5 23 [34] 30 55 0.211 ± 0.074 8.00 ±0.0  1.64 ± 1.50 Lower limit of quantitation was 0.0250 ng/mL

FIG. 8 compares mean plasma concentrations over time of tapentadolrelease following PO administration of prodrug Compound TP-5 to rats,with or without a co-dose of trypsin inhibitor.

The results in Table 7 and FIG. 8 indicate that trypsin inhibitorCompound 109 attenuates prodrug Compound TP-5's ability to releasetapentadol in rats.

Example 43 Pharmacokinetics of a Ketone-Modified Opioid ProdrugFollowing PO Administration of Increasing Doses of Such a Prodrug toRats

This Example demonstrates the release of opioid into plasma whenincreasing doses of a ketone-modified opioid prodrug of the embodimentswere administered orally (PO) to rats.

Increasing doses of Compound KC-31 (which can be prepared as describedin the examples herein) in sterile water or hydrocodone in sterile waterwere dosed as indicated in Table 8 via oral gavage into jugularvein-cannulated male Sprague Dawley rats (4 per group) that had beenfasted for 16-18 h prior to oral dosing. At specified time points, bloodsamples were collected, treated, and analyzed in a manner similar tothat described in Example 36.

Table 8 and FIG. 9 provide hydrocodone exposure results for ratsadministered Compound KC-31 or hydrocodone. Results in Table 8 arereported, for each group of rats, as (a) maximum plasma concentrationvalue (Cmax) of hydrocodone (HC) (average±standard deviation) and (b)time after administration of compound to reach maximum hydrocodoneconcentration value (Tmax) (average±standard deviation).

TABLE 8 Cmax, Tmax and AUC values of hydrocodone in rat plasma Dose,Dose HC Cmax ± sd, Compound mg/kg μmol/kg ng/mL Tmax ± sd, h KC-31 5 6 1.03 ± 0.083 1.25 ± 0.50 KC-31 10 12 1.77 ± 0.63 1.75 ± 0.50 KC-31 2328 3.87 ± 1.7  1.00 ± 0.0  Hydrocodone 10 30 5.49 ± 1.7  1.06 ± 0.72Lower limit of quantitation was 0.0500 ng/mL

FIG. 9 compares mean plasma concentrations over time of hydrocodonerelease following PO administration of increasing doses of CompoundKC-31 to rats.

The results in Table 8 and FIG. 9 indicate that plasma concentrations ofhydrocodone increase proportionally with dose of a prodrug of theembodiments administered to rats.

Example 44 In Vitro Trypsin-Mediated Prodrug Cleavage of Ketone-ModifiedOpioid Prodrugs

This Example assesses the ability of trypsin to cleave ketone-modifiedopioid prodrugs of the embodiments.

Compound KC-31, Compound KC-32, Compound KC-35, Compound KC-36, CompoundKC-37, Compound KC-38, Compound KC-39, and Compound KC-40 (each of whichcan be prepared as described in the examples herein) were each incubatedwith trypsin, and samples were collected and analyzed as described inExample 39.

Table 9 indicates the results of exposure of the tested prodrugs totrypsin. The results are expressed as half-life of prodrug when exposedto trypsin (i.e., Prodrug trypsin half-life) in hours, and rate ofhydrocodone formation in tmoles per hour per BAEE unit (tmol/h/BAEE U)trypsin.

TABLE 9 In vitro trypsin cleavage of prodrugs Prodrug trypsin HCformation rate, μmol/h/ Prodrug half-life, h * BAEE U Compound KC-310.065 ± 0.00  □ Compound KC-32 0.15 ± 0.00 □ Compound KC-35 0.008 ±0.00  □ Compound KC-36 0.018 ± 0.00  0.004 ± 0.00  Compound KC-37 0.00 ±0.00 0.004 ± 0.00  Compound KC-38 0.12 ± 0.01 0.001 ± 0.00  CompoundKC-39 0.398 ± 0.00  0.00 ± 0.00 Compound KC-40 0.010 ± 0.00  0.003 ±0.00  * Adjusted to 4815 BAEE U trypsin/mL □ not analyzed

The results in Table 9 indicate that prodrugs of the embodiments can becleaved by trypsin.

Example 45 Pharmacokinetics Following PO Administration ofKetone-Modified Opioid Prodrugs to Rats

This Example demonstrates the release of opioid into plasma whenketone-modified opioid prodrugs of the embodiments were administeredorally (PO) to rats.

Aqueous solutions of Compound KC-32, Compound KC-35, Compound KC-36,Compound KC-37, Compound KC-38, Compound KC-39, Compound KC-40, CompoundKC-47 and Compound KC-50 (each of which can be prepared as described inthe examples herein) or hydrocodone (Johnson Matthey, London, UK) weredosed as indicated in Table 10 to rats, using a method similar to thatdescribed in Example 36. Sampling and analysis procedures were alsosimilar to those described in Example 36.

Table 10 provides hydrocodone exposure (i.e., due to hydrocodone releasefrom prodrug) results for rats administered the indicated compounds.Results in Table 10 are reported, for each group of rats, as (a) maximumplasma concentration value (Cmax) of hydrocodone (HC) (average±standarddeviation) and (b) time after administration of compound to reachmaximum hydrocodone concentration value (Tmax) (average±standarddeviation).

TABLE 10 Cmax and Tmax of hydrocodone in rat plasma Dose, Dose HC Cmax ±Compound mg/kg μmol/kg sd, ng/mL Tmax ± sd, h KC-32 23 28 1.50 ±0.81{circumflex over ( )} 3.75 ± 2.9  KC-35 20 24 2.70 ± 0.46{circumflexover ( )} 1.00 ± 0.00 KC-36 21 27 5.43 ± 1.4*  0.958 ± 0.085 KC-37 22 285.61 ± 2.7*  1.17 ± 0.56 KC-38 20 28 5.83 ± 1.6*  1.00 ± 0.00 KC-39 2128 6.40 ± 3.7*  1.75 ± 0.50 KC-40 23 28 5.86 ± 1.8*  0.417 ± 0.096 KC-4724 28 4.24 ± 0.82{circumflex over ( )} 0.584 ± 0.096 KC-50 22 28 4.65 ±0.85{circumflex over ( )} 0.500 ± 0.00  hydrocodone 10 30 5.49 ±1.7{circumflex over ( )}  1.06 ± 0.72 {circumflex over ( )}Lower limitof quantitation was 0.0500 ng/mL *Lower limit of quantitation was 0.100ng/mL

FIG. 10, FIG. 11, and FIG. 12 compare mean plasma concentrations overtime of hydrocodone release following PO administration of hydrocodoneprodrugs of the embodiments to rats.

The results in Table 10, FIG. 10, FIG. 11 and FIG. 12 indicate that oraladministration to rats of each of the tested prodrugs leads to releaseof hydrocodone.

Example 46 Oral Administration of Ketone-Modified Opioid ProdrugsCo-Dosed with a Trypsin Inhibitor to Rats

This Example demonstrates the ability of a trypsin inhibitor to affectthe ability of ketone-modified opioid prodrugs of the embodiments torelease opioid into plasma when such ketone-modified opioid prodrugswere co-administered with such trypsin inhibitor orally to rats.

Aqueous solutions of prodrug Compound KC-40 or prodrug Compound KC-50(each of which can be prepared as described in the examples herein) wereco-dosed with increasing concentrations of Compound 109 (Catalog No.3081, Tocris Bioscience, Ellisville, Mo., USA or Catalog No. WS38665,Waterstone Technology, Carmel, Ind., USA) as indicated in Table 11A andTable 11B respectively, or hydrocodone to rats, using a method similarto that described in Example 36. Sampling and analysis procedures werealso similar to those described in Example 36.

Table 11A provides hydrocodone exposure results for rats administeredhydrocodone or 5 mg/kg (6 μmol/kg) or 50 mg/kg (62 mmol/kg) doses ofCompound KC-40 co-dosed with increasing amounts of trypsin inhibitorCompound 109. The hydrocodone Cmax and Tmax values in Table 11A arereported, for each group of three or four rats, as indicated in Table11A, and as described in Example 36.

TABLE 11A Cmax and Tmax of hydrocodone in rat plasma KC-40 Com- Com-KC-40 Dose, pound pound Dose, μmol/ 109 Dose, 109 Dose, HC Cmax ± mg/kgkg mg/kg μmol/kg sd, ng/mL Tmax ± sd, h 5 6 0   0 1.08 ± 0.17{circumflexover ( )} 1.00 ± 0.68 5 6 0.1  0.2 1.09 ± 0.27{circumflex over ( )}0.500 ± 0.00  5 6 0.25 0.44 1.19 ± 0.29{circumflex over ( )} 0.708 ±0.25  5 6 0.5  0.9 0.892 ± 0.16{circumflex over ( )}  1.09 ± 0.63 5 61.0  1.7 0.987 ± 0.55{circumflex over ( )}  1.00 ± 0.68 50 62 1   1.75.97 ± 1.4*  2.00 ± 0.00 50 62  2.5□ 4.4 7.37 ± 2.3*  2.33 ± 0.58 50 625   9.0 4.98 ± 2.0*  2.50 ± 0.58 50 62 10    17.4 5.43 ± 4.1*  4.00 ±1.2  Hydrocodone values in Table 10 11.9 ± n/a{circumflex over ( )} 1.06 ± n/a  adjusted to provide expected values at a 21.7 mg/kg (62μmol/kg) dose {circumflex over ( )}Lower limit of quantitation was0.0500 ng/mL *Lower limit of quantitation was 0.500 ng/mL □3 rats dosed

FIG. 13A compares mean plasma concentrations over time of hydrocodonerelease following PO administration to rats of a 5 mg/kg (6 μmol/kg)dose of prodrug Compound KC-40 with increasing amounts of co-dosedtrypsin inhibitor Compound 109. FIG. 13B compares mean plasmaconcentrations over time of hydrocodone release following POadministration to rats of a 50 mg/kg (62 μmol/kg) dose of prodrugCompound KC-40 with increasing amounts of co-dosed trypsin inhibitorCompound 109 to hydrocodone values expected from a 21.7 mg/kg (62μmol/kg) hydrocodone dose, based on the plasma concentrations ofhydrocodone release following PO administration to rats of 10 mg/kghydrocodone.

Table 11B provides hydrocodone exposure results for rats administeredhydrocodone or 5 mg/kg (6 μmol/kg) or 50 mg/kg (64 μmol/kg) doses ofCompound KC-50 each co-dosed with increasing amounts of trypsininhibitor Compound 109. The hydrocodone Cmax and Tmax values in Table11B are reported, for each group of four rats as described in Example36.

TABLE 11B Cmax and Tmax of hydrocodone in rat plasma KC-50 KC-50Compound Compound Dose, Dose, 109 Dose, 109 Dose, HC Cmax ± mg/kgμmol/kg mg/kg μmol/kg sd, ng/mL Tmax ± sd, h 5 6 0 0 1.45 ± 0.21 0.542 ±0.084 5 6 0.1 0.2 1.18 ± 0.16 0.500 ± 0.00  5 6 0.25 0.44 1.12 ± 0.270.667 ± 0.14  5 6 0.5 0.9 1.19 ± 0.44 1.00 ± 0.68 5 6 1.0 1.7 0.807 ±37   1.75 ± 0.50 50 64 1 1.7 5.28 ± 3.0  1.75 ± 0.50 50 64 2.5 4.4 4.49± 0.22 1.42 ± 0.69 50 64 5 9.0 5.11 ± 1.5  3.00 ± 1.2  Hydrocodonevalues in Table 10 adjusted 12.4 ± n/a  1.06 ± n/a  to provide expectedvalues at a 62 μmol/kg (21.7 mg/kg) dose Lower limit of quantitation was0.0500 ng/mL

FIG. 13C compares the mean plasma concentrations over time ofhydrocodone release following PO administration to rats of a 5 mg/kg (6μmol/kg) dose of prodrug Compound KC-50 with increasing amounts ofco-dosed trypsin inhibitor Compound 109. FIG. 13D compares mean plasmaconcentrations over time of hydrocodone release following POadministration to rats of a 50 mg/kg (62 μmol/kg) dose of prodrugCompound KC-50 with increasing amounts of co-dosed trypsin inhibitorCompound 109 to hydrocodone values expected from a 21.7 mg/kg (62μmol/kg) hydrocodone dose, based on the plasma concentrations ofhydrocodone release following PO administration to rats of 10 mg/kghydrocodone.

The results in Table 11A, Table 11B, FIG. 13A, FIG. 13B, FIG. 13C andFIG. 13D indicate Compound 109's ability to attenuate release ofhydrocodone by prodrugs of the embodiments.

Example 47 Pharmacokinetics of Ketone-Modified Opioid Prodrugs FollowingPO Administration to Dogs and Effects of Co-Administration of a TrypsinInhibitor

This Example demonstrates the release of hydrocodone into plasma whenketone-modified hydrocodone prodrugs of the embodiments wereadministered orally (PO) to dogs.

This Example also demonstrates the release of hydrocodone into plasmawhen an increasing number of dose units of a ketone-modified hydrocodoneprodrug and a trypsin inhibitor were administered PO to dogs.

Purebred male young adult/adult beagles were fasted overnight. Aqueoussolutions of either Compound KC-40 or Compound 50 (each of which can beprepared as described in the examples herein) as indicated in Table 12and Table 13, respectively, or 0.17 mg/kg hydrocodone were administeredvia oral gavage to the dogs (4 per group). The study also included (a)dogs that were dosed with an increasing number of dose units of CompoundKC-40 and Compound 109 as indicated in Table 12 and (b) dogs that wereco-dosed with Compound KC-50 and increasing doses of Compound 109, asindicated in Table 13.

Blood was collected from each animal via a jugular vein at various timesover a 24-h period, centrifuged, and 0.8 mL plasma transferred to afresh tube containing 8 μL formic acid; samples were vortexed, thenimmediately placed in dry ice, and stored in a −80° C. freezer untilanalysis by HPLC/MS.

Table 12 provides hydrocodone (HC) exposure results for dogsadministered either hydrocodone or increasing doses of prodrug CompoundKC-40. Table 12 also provides hydrocodone (HC) exposure results when anincreasing number of dose units of prodrug Compound KC-40 and trypsininhibitor Compound 109 (i.e., 1, 4 or 10 dose units) were administeredPO to dogs. The hydrocodone Cmax and Tmax values in Table 12 arereported, for each group of four dogs, as described in Example 36.

TABLE 12 Cmax and Tmax of hydrocodone in dog plasma Compound CompoundDose, Dose, 109 Dose 109 Dose HC Cmax ± Compound mg/kg μmol/kg mg/kgμmol/kg sd, ng/mL Tmax ± sd, h KC-40 0.1 0.1 n/a n/a 4.12 ± 1.2* 0.417 ±0.096 KC-40 0.4 0.5 n/a n/a 13.2 ± 2.7* 0.625 ± 0.14 KC-40 1.6 2.0 n/an/a 66.5 ± 8.1* 0.458 ± 0.084 KC-40 0.4 0.5 0.08 0.14 12.9 ±4.8{circumflex over ( )} 0.938 ± 0.13 KC-40 1.6 2.0 0.32 0.56 23.3 ± 12* 2.50 ± 0.58 KC-40 4 4.9 0.8  1.4  13.2 ± 7.6^(#)  5.00 ± 2.6hydrocodone 0.17 0.5 n/a n/a 14.0 ± 4.3{circumflex over ( )} 0.417 ±0.096 hydrocodone 0.17 Values adjusted to expected value for 56.0 ±n/a{circumflex over ( )} 0.417 ± n/a a 2 μmol/kg dose (4 doseequivalents) hydrocodone 0.17 Values adjusted to expected value for  140± n/a{circumflex over ( )} 0.417 ± n/a a 5 μmol/kg dose (10 dose equiv)^(#)Lower limit of quantitation was 0.0250 ng/mL {circumflex over( )}Lower limit of quantitation was 0.0500 ng/mL *Lower limit ofquantitation was 0.100 ng/mL

Table 13 provides hydrocodone (HC) exposure results for dogsadministered either hydrocodone or increasing amounts of prodrugCompound KC-50 and exposure results when Compound KC-50 was co-dosedwith increasing amounts of trypsin inhibitor Compound 109. Thehydrocodone Cmax and Tmax values in Table 13 are reported, for eachgroup of four dogs, as described in Example 36.

TABLE 13 Cmax and Tmax of hydrocodone in dog plasma Compound CompoundDose, Dose, 109 Dose 109 Dose HC Cmax ± Compound mg/kg μmol/kg mg/kgμmol/kg sd, ng/mL Tmax ± sd, h KC-50 0.1 0.1 n/a n/a 3.74 ± 1.3* 0.625 ±0.025 KC-50 0.4 0.5 n/a n/a 9.69 ± 3.8^(§) 0.604 ± 0.33 KC-50 1.6 2 n/an/a 55.9 ± 18* 0.563 ± 0.13 KC-50 0.4 0.5 0.08 0.14 8.26 ± 5.4*  1.75 ±0.50 KC-50 0.4 0.5 0.16 0.28 8.63 ± 1.1*  1.75 ± 0.50 KC-50 4 5 0.080.14 70.2 ± 30^(#)  2.25 ± 0.50 KC-50 4 5 0.4  0.7  47.8 ± 23^(#)  4.25± 2.1 hydrocodone 0.17 0.5 n/a n/a 14.0 ± 4.3{circumflex over ( )} 0.417± 0.096 hydrocodone 0.17 Values adjusted to expected value for  140 ±n/a{circumflex over ( )} 0.417 ± n/a a 5 μmol/kg dose (10 dose equiv)^(§)Lower limit of quantitation was 0.0125 ng/mL ^(#)Lower limit ofquantitation was 0.0250 ng/mL {circumflex over ( )}Lower limit ofquantitation was 0.0500 ng/mL *Lower limit of quantitation was 0.100ng/mL

FIG. 14A compares mean plasma concentrations over time of hydrocodonefollowing PO administration to dogs of hydrocodone or of increasingamounts of Compound KC-40. FIG. 14B, FIGS. 14C and 14D each comparesmean plasma concentrations over time of hydrocodone following POadministration to dogs of, respectively, 1, 4 and 10 dose unitscomprising prodrug Compound KC-40 and trypsin inhibitor Compound 109 toplasma concentrations of hydrocodone following PO administered to dogsof 1 dose equivalent of hydrocodone or predicted concentrations for 4 or10 dose equivalents of hydrocodone, respectively.

FIG. 15A compares mean plasma concentrations over time of hydrocodonefollowing PO administration of hydrocodone or of increasing amounts ofCompound KC-50 to dogs. FIG. 15B and FIG. 15C compare mean plasmaconcentrations over time of hydrocodone following PO administration todogs of hydrocodone to plasma concentrations over time of hydrocodonefollowing PO administration to dogs of the indicated doses of CompoundKC-50 with or without trypsin inhibitor Compound 109.

The results in Table 12, Table 13, FIG. 14A-D and FIG. 15A-C indicatethat prodrug compounds of the embodiments administered orally to dogseffect efficient release of hydrocodone into dog plasma. The resultsalso demonstrate that release of hydrocodone can be attenuated (a) withan increasing number of dose units comprising prodrug and trypsininhibitor compared to administration of an equivalent dosage of drugalone as well as (b) with a co-dose of prodrug and increasing amounts oftrypsin inhibitor compared to administration of an equivalent dosage ofdrug alone.

Example 48 Pharmacokinetics Following PO Administration ofKetone-Modified Opioid Prodrugs to Rats

This Example demonstrates the release of opioid into plasma whenketone-modified opioid prodrug Compound KC-55 of the embodiments wasadministered orally (PO) to rats.

Aqueous solutions of Compound KC-55 (which can be prepared as describedin the examples herein) or saline solutions of oxycodone were dosed asindicated in Table 14 via oral gavage into jugular vein-cannulated maleSprague Dawley rats (4 per group) that had been fasted for 16-18 h priorto oral dosing. At specified time points, blood samples were drawn andharvested using a method similar to that described in Example 36.Sampling and analysis procedures were also similar to those described inExample 36.

Table 14 provides oxycodone exposure results for rats administeredoxycodone or Compound KC-55. Results in Table 14 are reported, for eachgroup of rats, as (a) maximum plasma concentration value (Cmax) ofoxycodone (OC) (average±standard deviation), and (b) time afteradministration of compound to reach maximum oxycodone concentrationvalue (Tmax) (average±standard deviation)

TABLE 14 Cmax, Tmax and AUC values of oxycodone in rat plasma Dose, DoseOC Cmax ± Compound mg/kg μmol/kg sd, ng/mL Tmax ± sd, h KC-55 5 6 2.73 ±1.4^(#)  0.542 ± 0.21 KC-55 23.5 28 15.9 ± 2.3*  0.500 ± 0.00 Oxycodone10 28 14.7 ± 6.5{circumflex over ( )}   0.625 ± 0.43 {circumflex over( )}Lower limit of quantitation was 0.0250 ng/mL *Lower limit ofquantitation was 0.0500 ng/mL ^(#)Lower limit of quantitation was 0.500ng/mL

FIG. 16 compares mean plasma concentrations over time of oxycodonerelease following PO administration to rats of oxycodone prodrugCompound KC-55 or oxycodone.

The results in Table 14 and FIG. 16 indicate that oral administration ofCompound KC-55 to rats leads to release of oxycodone.

Example 49 Oral Administration of Ketone-Modified Opioid ProdrugCompound KC-55 Co-Dosed with a Trypsin Inhibitor to Rats

This Example demonstrates the ability of a trypsin inhibitor to affectthe ability of ketone-modified opioid prodrug Compound KC-55 to releaseopioid into plasma when the prodrug is co-administered with such atrypsin inhibitor orally to rats.

Aqueous solutions of prodrug Compound KC-55 (which can be prepared asdescribed in the examples herein), aqueous solutions of an increasingnumber of dose units comprising Compound KC-55 and Compound 109 (CatalogNo. 3081, Tocris Bioscience, Ellisville, Mo., USA or Catalog No.WS38665, Waterstone Technology, Carmel, Ind., USA), or a saline solutionof oxycodone were administered orally to rats, as indicated in Table 15,using a method similar to that described in Example 36. Sampling andanalysis procedures were also similar to those described in Example 36.

Table 15 provides oxycodone exposure results for rats administeredoxycodone, Compound KC-55, or a single dose unit or 6 dose unitscomprising Compound KC-55 and trypsin inhibitor Compound 109. Theoxycodone Cmax and Tmax values, in Table 15 are reported, for each groupof four rats, as described in Example 36.

TABLE 15 Cmax and Tmax of oxycodone in rat plasma KC-55 KC-55 CompoundCompound Dose, Dose, 109 Dose, 109 Dose, OC Cmax ± Tmax ± sd, mg/kgμmol/kg mg/kg μmol/kg sd, ng/mL h 5 6 0 0 2.73 ± 1.4  0.542 ± 0.21  5 60.5 0.9 3.59 ± 2.0  0.583 ± 0.17  30 36 3 5 9.96 ± 3.4  0.875 ± 0.16 Oxycodone values in Table 14 adjusted to 18.8 ± n/a  0.625 ± n/a provide expected values at a 36 μmol/kg dose Lower limit of quantitationwas 0.500 ng/mL

FIG. 17A provides oxycodone exposure results for rats orallyadministered a 5 mg/kg (6 μmol/kg) dose of Compound KC-55 alone orco-dosed with 0.5 mg/kg (0.9 μmol/kg) of trypsin inhibitor Compound 109.

FIG. 17B provides oxycodone exposure results for rats orallyadministered a 30 mg/kg (36 μmol/kg) dose of Compound KC-55 alone orco-dosed with 3 mg/kg (5 μmol/kg) of trypsin inhibitor Compound 109.

The results in Table 15 and the Figures demonstrate that release ofoxycodone can be attenuated with an increasing number of dose unitscomprising prodrug and trypsin inhibitor compared to administration ofan equivalent dosage of drug alone.

While the present invention has been described with reference to thespecific embodiments thereof, it should be understood by those skilledin the art that various changes may be made and equivalents may besubstituted without departing from the true spirit and scope of theinvention. In addition, many modifications may be made to adapt aparticular situation, material, composition of matter, process, processstep or steps, to the objective, spirit and scope of the presentinvention. All such modifications are intended to be within the scope ofthe claims appended hereto.

What is claimed is:
 1. A method of treating or preventing pain in apatient in need thereof, which comprises administering an effectiveamount of a composition comprising a pharmaceutically acceptableexcipient and a compound of formula III:

or a compound of formula VI:

wherein X is hydromorphone, morphine or oxymorphone; R^(a) is hydrogenor hydroxyl; R^(b) is hydrogen or alkyl; the A ring is a heterocyclic 5to 12-membered ring; each Y is independently selected from alkyl,substituted alkyl, alkenyl, substituted alkenyl, alkynyl, substitutedalkynyl, aryl, substituted aryl, acyl, substituted acyl, carboxyl,alkoxycarbonyl, substituted alkoxycarbonyl, aminoacyl, substitutedaminoacyl, amino, substituted amino, acylamino, substituted acylamino,and cyano; c is a number from zero to 3; each R¹ is independentlyselected from hydrogen, alkyl, substituted alkyl, alkenyl, substitutedalkenyl, alkynyl, substituted alkynyl, aryl, substituted aryl, acyl,substituted acyl, carboxyl, alkoxycarbonyl, substituted alkoxycarbonyl,aminoacyl, substituted aminoacyl, amino, substituted amino, acylamino,substituted acylamino, and cyano; each R² is independently selected fromhydrogen, alkyl, substituted alkyl, alkenyl, substituted alkenyl,alkynyl, substituted alkynyl, aryl, substituted aryl, acyl, substitutedacyl, carboxyl, alkoxycarbonyl, substituted alkoxycarbonyl, aminoacyl,substituted aminoacyl, amino, substituted amino, acylamino, substitutedacylamino, and cyano; or R¹ and R² together with the carbon to whichthey are attached can form a cycloalkyl or substituted cycloalkyl group,or two R¹ or R² groups on adjacent carbon atoms, together with thecarbon atoms to which they are attached, can form a cycloalkyl orsubstituted cycloalkyl group; a is an integer from one to 8; providedthat when a is one, the A ring is a heterocyclic 6 to 12-membered ring;and when the A ring is a heterocyclic 5-membered ring, then a is aninteger from 2 to 8; each R³ is independently hydrogen, alkyl,substituted alkyl, aryl or substituted aryl; R⁵ is selected fromhydrogen, alkyl, substituted alkyl, aryl, substituted aryl, arylalkyl,substituted arylalkyl, heteroalkyl, substituted heteroalkyl, heteroaryl,substituted heteroaryl, heteroarylalkyl, and substitutedheteroarylalkyl; each R⁶ is independently selected from hydrogen, alkyl,substituted alkyl, aryl, substituted aryl, arylalkyl, substitutedarylalkyl, heteroalkyl, substituted heteroalkyl, heteroaryl, substitutedheteroaryl, heteroarylalkyl, and substituted heteroarylalkyl; b is anumber from zero to 100; and R⁷ is selected from hydrogen, alkyl,substituted alkyl, acyl, substituted acyl, alkoxycarbonyl, substitutedalkoxycarbonyl, aryl, substituted aryl, arylalkyl, and substitutedarylalkyl; or a salt, hydrate or solvate thereof.
 2. The method of claim1, wherein the compound is of formula III:

wherein R^(a) is hydrogen or hydroxyl; R^(b) is hydrogen or alkyl; the Aring is a heterocyclic 5 to 12-membered ring; each Y is independentlyselected from alkyl, substituted alkyl, alkenyl, substituted alkenyl,alkynyl, substituted alkynyl, aryl, substituted aryl, acyl, substitutedacyl, carboxyl, alkoxycarbonyl, substituted alkoxycarbonyl, aminoacyl,substituted aminoacyl, amino, substituted amino, acylamino, substitutedacylamino, and cyano; c is a number from zero to 3; each R¹ isindependently selected from hydrogen, alkyl, substituted alkyl, alkenyl,substituted alkenyl, alkynyl, substituted alkynyl, aryl, substitutedaryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl, substitutedalkoxycarbonyl, aminoacyl, substituted aminoacyl, amino, substitutedamino, acylamino, substituted acylamino, and cyano; each R² isindependently selected from hydrogen, alkyl, substituted alkyl, alkenyl,substituted alkenyl, alkynyl, substituted alkynyl, aryl, substitutedaryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl, substitutedalkoxycarbonyl, aminoacyl, substituted aminoacyl, amino, substitutedamino, acylamino, substituted acylamino, and cyano; or R¹ and R²together with the carbon to which they are attached can form acycloalkyl or substituted cycloalkyl group, or two R¹ or R² groups onadjacent carbon atoms, together with the carbon atoms to which they areattached, can form a cycloalkyl or substituted cycloalkyl group; a is aninteger from one to 8; provided that when a is one, the A ring is aheterocyclic 6 to 12-membered ring; and when the A ring is aheterocyclic 5-membered ring, then a is an integer from 2 to 8; each R³is independently hydrogen, alkyl, substituted alkyl, aryl or substitutedaryl; R⁵ is selected from hydrogen, alkyl, substituted alkyl, aryl,substituted aryl, arylalkyl, substituted arylalkyl, heteroalkyl,substituted heteroalkyl, heteroaryl, substituted heteroaryl,heteroarylalkyl, and substituted heteroarylalkyl; each R⁶ isindependently selected from hydrogen, alkyl, substituted alkyl, aryl,substituted aryl, arylalkyl, substituted arylalkyl, heteroalkyl,substituted heteroalkyl, heteroaryl, substituted heteroaryl,heteroarylalkyl, and substituted heteroarylalkyl; b is a number fromzero to 100; and R⁷ is selected from hydrogen, alkyl, substituted alkyl,acyl, substituted acyl, alkoxycarbonyl, substituted alkoxycarbonyl,aryl, substituted aryl, arylalkyl, and substituted arylalkyl; or a salt,hydrate or solvate thereof.
 3. The method of claim 2, wherein R^(a) ishydrogen or hydroxyl.
 4. The method of claim 2, wherein R^(b) ishydrogen or alkyl.
 5. The method of claim 2, wherein: R^(a) is hydrogenand R^(b) is hydrogen; or R^(a) is hydroxyl and R^(b) is hydrogen; orR^(a) is hydrogen and R^(b) is alkyl; or R^(a) is hydroxyl and R^(b) isalkyl.
 6. The method of claim 2, wherein: R^(a) is hydrogen and R^(b) isalkyl; or R^(a) is hydroxyl and R^(b) is alkyl.
 7. The method of claim2, wherein R^(a) is hydrogen and R^(b) is methyl.
 8. The method of claim2, wherein R^(a) is hydroxyl and R^(b) is methyl.
 9. The method of claim2, wherein R⁵ is selected from hydrogen, alkyl, substituted alkyl,arylalkyl, substituted arylalkyl, heteroarylalkyl, and substitutedheteroarylalkyl.
 10. The method of claim 2, wherein R⁵ represents a sidechain of an amino acid, a side chain of an amino acid variant, aderivative of a side chain of an amino acid, or a derivative of a sidechain of an amino acid variant that effects —C(O)—CH(R⁵)—N(R³)— to be aGI enzyme-cleavable moiety.
 11. The method of claim 2, wherein R⁵ is aside chain of an amino acid selected from alanine, arginine, asparagine,aspartic acid, cysteine, glutamic acid, glutamine, glycine, histidine,isoleucine, leucine, lysine, methionine, phenylalanine, proline, serine,threonine, tryptophan, tyrosine, valine, homoarginine, homolysine,ornithine, arginine mimic, arginine homologue, arginine truncate,arginine with varying oxidation states, lysine mimic, lysine homologue,lysine truncate, and lysine with varying oxidation states.
 12. Themethod of claim 2, wherein R⁵ is a side chain of an L-amino acidselected from L-alanine, L-arginine, L-asparagine, L-aspartic acid,L-cysteine, L-glutamic acid, L-glutamine, glycine, L-histidine,L-isoleucine, L-leucine, L-lysine, L-methionine, L-phenylalanine,L-proline, L-serine, L-threonine, L-tryptophan, L-tyrosine, L-valine,L-homoarginine, L-homolysine, L-ornithine, L-arginine mimic, L-argininehomologue, L-arginine truncate, L-arginine with varying oxidationstates, L-lysine mimic, L-lysine homologue, L-lysine truncate, andL-lysine with varying oxidation states.
 13. The method of claim 2,wherein R⁵ is a side chain of an L-amino acid selected from L-alanine,L-arginine, L-asparagine, L-aspartic acid, L-cysteine, L-glutamic acid,L-glutamine, glycine, L-histidine, L-isoleucine, L-leucine, L-lysine,L-methionine, L-phenylalanine, L-proline, L-serine, L-threonine,L-tryptophan, L-tyrosine, and L-valine.
 14. The method of claim 2,wherein R⁵ is a side chain of an amino acid selected from arginine,lysine, homoarginine, homolysine, ornithine, arginine mimic, argininehomologue, arginine truncate, arginine with varying oxidation states,lysine mimic, lysine homologue, lysine truncate, and lysine with varyingoxidation states.
 15. The method of claim 2, wherein R⁵ is a side chainof an L-amino acid selected from L-arginine, L-lysine, L-homoarginine,L-homolysine, L-ornithine, L-arginine mimic, L-arginine homologue,L-arginine truncate, L-arginine with varying oxidation states, L-lysinemimic, L-lysine homologue, L-lysine truncate, and L-lysine with varyingoxidation states.
 16. The method of claim 2, wherein R⁵ is a side chainof an L-amino acid selected from L-arginine, L-lysine, L-homoarginine,L-homolysine, and L-ornithine.
 17. The method of claim 2, wherein R⁵represents —CH₂CH₂CH₂NH(C(═NH)(NH₂)) or —CH₂CH₂CH₂CH₂NH₂, theconfiguration of the carbon atom to which R⁵ is attached correspondingwith that in an L-amino acid.
 18. The method of claim 2, wherein R⁵ is aside chain of an amino acid selected from L-arginine and L-lysine and bis one.
 19. The method of claim 2, wherein R⁶ is a side chain of anL-amino acid independently selected from L-alanine, L-arginine,L-asparagine, L-aspartic acid, L-cysteine, L-glutamic acid, L-glutamine,glycine, L-histidine, L-isoleucine, L-leucine, L-lysine, L-methionine,L-phenylalanine, L-proline, L-serine, L-threonine, L-tryptophan,L-tyrosine, and L-valine.
 20. The method of claim 2, wherein R⁶ that isimmediately adjacent to R⁵ represents —H or —CH₃, the configuration ofthe carbon atom to which R⁶ is attached corresponding with that in anL-amino acid.
 21. The method of claim 2, wherein R⁵ is a side chain ofan amino acid selected from L-arginine and L-lysine; R⁶ is a side chainof an amino acid selected from L-alanine and glycine; and b is one. 22.The method of claim 2, wherein R⁵ is a side chain of an amino acidselected from L-arginine and L-lysine; R⁶ is a side chain of glycine;and b is one.
 23. The method of claim 2, wherein R⁵ is a side chain ofan amino acid selected from L-arginine and L-lysine; R⁶ is a side chainof L-alanine; and b is one.
 24. The method of claim 2, wherein R⁵ is aside chain of L-arginine; R⁶ is a side chain of glycine; and b is one.25. The method of claim 2, wherein R⁵ is a side chain of L-arginine; R⁶is a side chain of L-alanine; and b is one.
 26. The method of claim 2,wherein R⁵ is a side chain of L-lysine; R⁶ is a side chain of glycine;and b is one.
 27. The method of claim 2, wherein R⁵ is a side chain ofL-lysine; R⁶ is a side chain of alanine; and b is one.
 28. The method ofclaim 2, wherein A ring is a heterocyclic 5 or 6-membered ring.
 29. Themethod of claim 2, wherein A ring is a heterocyclic 5-membered ring anda is
 2. 30. The method of claim 2, wherein A ring is a heterocyclic6-membered ring and a is one.
 31. The method of claim 2, wherein R¹ isindependently selected from hydrogen, alkyl, substituted alkyl, aryl,substituted aryl, acyl, and aminoacyl.
 32. The method of claim 2,wherein R² is independently selected from hydrogen, alkyl, substitutedalkyl, aryl, substituted aryl, acyl, and aminoacyl.
 33. The method ofclaim 2, wherein R¹ and R² are hydrogen.
 34. The method of claim 2,wherein R¹ and R² which are on the same carbon are alkyl.
 35. The methodof claim 2, wherein R¹ and R² which are on the same carbon are methyl.36. The method of claim 2, wherein R¹ and R¹ which are vicinal are bothalkyl and R² and R² which are vicinal are both hydrogen.
 37. The methodof claim 2, wherein R¹ and R¹ which are vicinal are both methyl and R²and R² which are vicinal are both hydrogen.
 38. The method of claim 2,wherein one of R¹ and R² is carboxyl.
 39. The method of claim 2, whereinone of R¹ and R² is amino.
 40. The method of claim 2, wherein one of R¹and R² is aminoacyl.
 41. The method of claim 2, wherein Y is carboxyl.42. The method of claim 2, wherein Y is amino.
 43. The method of claim2, wherein Y is aminoacyl.
 44. The method of claim 2, wherein c is zeroor one.
 45. The method of claim 2, wherein c is zero.
 46. The method ofclaim 2, wherein c is one.
 47. The method of claim 2, wherein b is anumber from zero to
 50. 48. The method of claim 2, wherein b is zero orone.
 49. The method of claim 2, wherein R³ is hydrogen or alkyl.
 50. Themethod of claim 2, wherein R⁷ is hydrogen, acyl, or substituted acyl.51. The method of claim 2, wherein R⁷ is selected from hydrogen, acetyl,benzoyl, malonyl, piperonyl and succinyl.
 52. The method of claim 2,wherein R⁷ is acetyl or malonyl.
 53. The method of claim 2, wherein thecompound is of the following formula:


54. The method of claim 2, wherein the compound is of the followingformula:


55. The method of claim 1, wherein the compound is of formula VI:

wherein X is hydromorphone, morphine or oxymorphone; the A ring is aheterocyclic 5 to 12-membered ring; each Y is independently selectedfrom alkyl, substituted alkyl, alkenyl, substituted alkenyl, alkynyl,substituted alkynyl, aryl, substituted aryl, acyl, substituted acyl,carboxyl, alkoxycarbonyl, substituted alkoxycarbonyl, aminoacyl,substituted aminoacyl, amino, substituted amino, acylamino, substitutedacylamino, and cyano; c is a number from zero to 3; each R¹ isindependently selected from hydrogen, alkyl, substituted alkyl, alkenyl,substituted alkenyl, alkynyl, substituted alkynyl, aryl, substitutedaryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl, substitutedalkoxycarbonyl, aminoacyl, substituted aminoacyl, amino, substitutedamino, acylamino, substituted acylamino, and cyano; each R² isindependently selected from hydrogen, alkyl, substituted alkyl, alkenyl,substituted alkenyl, alkynyl, substituted alkynyl, aryl, substitutedaryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl, substitutedalkoxycarbonyl, aminoacyl, substituted aminoacyl, amino, substitutedamino, acylamino, substituted acylamino, and cyano; or R¹ and R²together with the carbon to which they are attached can form acycloalkyl or substituted cycloalkyl group, or two R¹ or R² groups onadjacent carbon atoms, together with the carbon atoms to which they areattached, can form a cycloalkyl or substituted cycloalkyl group; a is aninteger from one to 8; provided that when a is one, the A ring is aheterocyclic 6 to 12-membered ring; and when the A ring is aheterocyclic 5-membered ring, then a is an integer from 2 to 8; each R³is independently hydrogen, alkyl, substituted alkyl, aryl or substitutedaryl; R⁵ is selected from hydrogen, alkyl, substituted alkyl, aryl,substituted aryl, arylalkyl, substituted arylalkyl, heteroalkyl,substituted heteroalkyl, heteroaryl, substituted heteroaryl,heteroarylalkyl, and substituted heteroarylalkyl; each R⁶ isindependently selected from hydrogen, alkyl, substituted alkyl, aryl,substituted aryl, arylalkyl, substituted arylalkyl, heteroalkyl,substituted heteroalkyl, heteroaryl, substituted heteroaryl,heteroarylalkyl, and substituted heteroarylalkyl; b is a number fromzero to 100; R⁷ is selected from hydrogen, alkyl, substituted alkyl,acyl, substituted acyl, alkoxycarbonyl, substituted alkoxycarbonyl,aryl, substituted aryl, arylalkyl, and substituted arylalkyl; or a salt,hydrate or solvate thereof.
 56. The method of claim 55, wherein X ishydromorphone.
 57. The method of claim 55, wherein X is morphine. 58.The method of claim 55, wherein X is oxymorphone.
 59. The method ofclaim 55, wherein X represents a residue of morphine, wherein thehydrogen atom of the phenolic hydroxyl group is replaced by a covalentbond to —C(O)—N[(Aring)-Y_(c)]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)_(b)]—R⁷;the A ring is a heterocyclic 6-membered ring; a is one; b is one; c iszero; R¹ and R² are independently hydrogen; R³ is hydrogen; R⁵ is a sidechain of amino acid L-arginine R⁶ is a side chain of amino acid glycine;and R⁷ is acetyl; or a salt, hydrate or solvate thereof.
 60. The methodof claim 55, wherein X represents a residue of hydromorphone, whereinthe hydrogen atom of the phenolic hydroxyl group is replaced by acovalent bond to —C(O)—N[(Aring)-Y_(c)]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)_(b)]—R⁷;the A ring is a heterocyclic 6-membered ring; a is one; b is one; c iszero; R¹ and R² are independently hydrogen; R³ is hydrogen; R⁵ is a sidechain of amino acid L-arginine R⁶ is a side chain of amino acid glycine;and R⁷ is acetyl; or a salt, hydrate or solvate thereof.
 61. The methodof claim 55, wherein X represents a residue of oxymorphone, wherein thehydrogen atom of the phenolic hydroxyl group is replaced by a covalentbond to —C(O)—N[(Aring)-Y_(c)]—(CR¹R²)_(a)—NH—C(O)—CH(R⁵)—N(R³)—[C(O)—CH(R⁶)—N(R³)_(b)]—R⁷;the A ring is a heterocyclic 6-membered ring; a is one; b is one; c iszero; R¹ and R² are independently hydrogen; R³ is hydrogen; R⁵ is a sidechain of amino acid L-arginine R⁶ is a side chain of amino acid glycine;and R⁷ is acetyl; or a salt, hydrate or solvate thereof.
 62. The methodof claim 55, wherein R⁵ is selected from hydrogen, alkyl, substitutedalkyl, arylalkyl, substituted arylalkyl, heteroarylalkyl, andsubstituted heteroarylalkyl.
 63. The method of claim 55, wherein R⁵represents a side chain of an amino acid, a side chain of an amino acidvariant, a derivative of a side chain of an amino acid, or a derivativeof a side chain of an amino acid variant that effects—C(O)—CH(R⁵)—N(R³)— to be a GI enzyme-cleavable moiety.
 64. The methodof claim 55, wherein R⁵ is a side chain of an amino acid selected fromalanine, arginine, asparagine, aspartic acid, cysteine, glutamic acid,glutamine, glycine, histidine, isoleucine, leucine, lysine, methionine,phenylalanine, proline, serine, threonine, tryptophan, tyrosine, valine,homoarginine, homolysine, ornithine, arginine mimic, arginine homologue,arginine truncate, arginine with varying oxidation states, lysine mimic,lysine homologue, lysine truncate, and lysine with varying oxidationstates.
 65. The method of claim 55, wherein R⁵ is a side chain of anL-amino acid selected from L-alanine, L-arginine, L-asparagine,L-aspartic acid, L-cysteine, L-glutamic acid, L-glutamine, glycine,L-histidine, L-isoleucine, L-leucine, L-lysine, L-methionine,L-phenylalanine, L-proline, L-serine, L-threonine, L-tryptophan,L-tyrosine, L-valine, L-homoarginine, L-homolysine, L-ornithine,L-arginine mimic, L-arginine homologue, L-arginine truncate, L-argininewith varying oxidation states, L-lysine mimic, L-lysine homologue,L-lysine truncate, and L-lysine with varying oxidation states.
 66. Themethod of claim 55, wherein R⁵ is a side chain of an L-amino acidselected from L-alanine, L-arginine, L-asparagine, L-aspartic acid,L-cysteine, L-glutamic acid, L-glutamine, glycine, L-histidine,L-isoleucine, L-leucine, L-lysine, L-methionine, L-phenylalanine,L-proline, L-serine, L-threonine, L-tryptophan, L-tyrosine, andL-valine.
 67. The method of claim 55, wherein R⁵ is a side chain of anamino acid selected from arginine, lysine, homoarginine, homolysine,ornithine, arginine mimic, arginine homologue, arginine truncate,arginine with varying oxidation states, lysine mimic, lysine homologue,lysine truncate, and lysine with varying oxidation states.
 68. Themethod of claim 55, wherein R⁵ is a side chain of an L-amino acidselected from L-arginine, L-lysine, L-homoarginine, L-homolysine,L-ornithine, L-arginine mimic, L-arginine homologue, L-argininetruncate, L-arginine with varying oxidation states, L-lysine mimic,L-lysine homologue, L-lysine truncate, and L-lysine with varyingoxidation states.
 69. The method of claim 55, wherein R⁵ is a side chainof an L-amino acid selected from L-arginine, L-lysine, L-homoarginine,L-homolysine, and L-ornithine.
 70. The method of claim 55, wherein R⁵represents —CH₂CH₂CH₂NH(C(═NH)(NH₂)) or —CH₂CH₂CH₂CH₂NH₂, theconfiguration of the carbon atom to which R⁵ is attached correspondingwith that in an L-amino acid.
 71. The method of claim 55, wherein R⁵ isa side chain of an amino acid selected from L-arginine and L-lysine andb is one.
 72. The method of claim 55, wherein R⁶ is a side chain of anL-amino acid independently selected from L-alanine, L-arginine,L-asparagine, L-aspartic acid, L-cysteine, L-glutamic acid, L-glutamine,glycine, L-histidine, L-isoleucine, L-leucine, L-lysine, L-methionine,L-phenylalanine, L-proline, L-serine, L-threonine, L-tryptophan,L-tyrosine, and L-valine.
 73. The method of claim 55, wherein R⁶ that isimmediately adjacent to R⁵ represents —H or —CH₃, the configuration ofthe carbon atom to which R⁶ is attached corresponding with that in anL-amino acid.
 74. The method of claim 55, wherein R⁵ is a side chain ofan amino acid selected from L-arginine and L-lysine; R⁶ is a side chainof an amino acid selected from L-alanine and glycine; and b is one. 75.The method of claim 55, wherein R⁵ is a side chain of an amino acidselected from L-arginine and L-lysine; R⁶ is a side chain of glycine;and b is one.
 76. The method of claim 55, wherein R⁵ is a side chain ofan amino acid selected from L-arginine and L-lysine; R⁶ is a side chainof L-alanine; and b is one.
 77. The method of claim 55, wherein R⁵ is aside chain of L-arginine; R⁶ is a side chain of glycine; and b is one.78. The method of claim 55, wherein R⁵ is a side chain of L-arginine; R⁶is a side chain of L-alanine; and b is one.
 79. The method of claim 55,wherein R⁵ is a side chain of L-lysine; R⁶ is a side chain of glycine;and b is one.
 80. The method of claim 55, wherein R⁵ is a side chain ofL-lysine; R⁶ is a side chain of alanine; and b is one.
 81. The method ofclaim 55, wherein A ring is a heterocyclic 5 or 6-membered ring.
 82. Themethod of claim 55, wherein A ring is a heterocyclic 5-membered ring anda is
 2. 83. The method of claim 55, wherein A ring is a heterocyclic6-membered ring and a is one.
 84. The method of claim 55, wherein R¹ isindependently selected from hydrogen, alkyl, substituted alkyl, aryl,substituted aryl, acyl, and aminoacyl.
 85. The method of claim 55,wherein R² is independently selected from hydrogen, alkyl, substitutedalkyl, aryl, substituted aryl, acyl, and aminoacyl.
 86. The method ofclaim 55, wherein R¹ and R² are hydrogen.
 87. The method of claim 55,wherein R¹ and R² which are on the same carbon are alkyl.
 88. The methodof claim 55, wherein R¹ and R² which are on the same carbon are methyl.89. The method of claim 55, wherein R¹ and R¹ which are vicinal are bothalkyl and R² and R² which are vicinal are both hydrogen.
 90. The methodof claim 55, wherein R¹ and R¹ which are vicinal are both methyl and R²and R² which are vicinal are both hydrogen.
 91. The method of claim 55,wherein one of R¹ and R² is carboxyl.
 92. The method of claim 55,wherein one of R¹ and R² is amino.
 93. The method of claim 55, whereinone of R¹ and R² is aminoacyl.
 94. The method of claim 55, wherein Y iscarboxyl.
 95. The method of claim 55, wherein Y is amino.
 96. The methodof claim 55, wherein Y is aminoacyl.
 97. The method of claim 55, whereinc is zero or one.
 98. The method of claim 55, wherein c is zero.
 99. Themethod of claim 55, wherein c is one.
 100. The method of claim 55,wherein b is a number from zero to
 50. 101. The method of claim 55,wherein b is zero or one.
 102. The method of claim 55, wherein R³ ishydrogen or alkyl.
 103. The method of claim 55, wherein R⁷ is hydrogen,acyl, or substituted acyl.
 104. The method of claim 55, wherein R⁷ isselected from hydrogen, acetyl, benzoyl, malonyl, piperonyl andsuccinyl.
 105. The method of claim 55, wherein R⁷ is acetyl or malonyl.106. The method of claim 1, wherein the composition comprises a trypsininhibitor.
 107. The method of claim 106, wherein the trypsin inhibitoris derived from soybean.
 108. The method of claim 106, wherein thetrypsin inhibitor is an arginine mimic or a lysine mimic.
 109. Themethod of claim 108, wherein the arginine mimic or lysine mimic is asynthetic compound.
 110. The method of claim 106, wherein the trypsininhibitor is Compound
 109. 111. A method of treating or preventing painin a patient in need thereof, which comprises administering an effectiveamount of a composition comprising: an opioid prodrug comprising anopioid covalently bound to a promoiety comprising a GI enzyme-cleavablemoiety, wherein cleavage of the GI enzyme-cleavable moiety by a GIenzyme mediates release of the opioid; wherein the opioid prodrug is offormula III:

or is of formula VI:

wherein X is hydromorphone, morphine or oxymorphone; R^(a) is hydrogenor hydroxyl; R^(b) is hydrogen or alkyl; the A ring is a heterocyclic 5to 12-membered ring; each Y is independently selected from alkyl,substituted alkyl, alkenyl, substituted alkenyl, alkynyl, substitutedalkynyl, aryl, substituted aryl, acyl, substituted acyl, carboxyl,alkoxycarbonyl, substituted alkoxycarbonyl, aminoacyl, substitutedaminoacyl, amino, substituted amino, acylamino, substituted acylamino,and cyano; c is a number from zero to 3; each R¹ is independentlyselected from hydrogen, alkyl, substituted alkyl, alkenyl, substitutedalkenyl, alkynyl, substituted alkynyl, aryl, substituted aryl, acyl,substituted acyl, carboxyl, alkoxycarbonyl, substituted alkoxycarbonyl,aminoacyl, substituted aminoacyl, amino, substituted amino, acylamino,substituted acylamino, and cyano; each R² is independently selected fromhydrogen, alkyl, substituted alkyl, alkenyl, substituted alkenyl,alkynyl, substituted alkynyl, aryl, substituted aryl, acyl, substitutedacyl, carboxyl, alkoxycarbonyl, substituted alkoxycarbonyl, aminoacyl,substituted aminoacyl, amino, substituted amino, acylamino, substitutedacylamino, and cyano; or R¹ and R² together with the carbon to whichthey are attached can form a cycloalkyl or substituted cycloalkyl group,or two R¹ or R² groups on adjacent carbon atoms, together with thecarbon atoms to which they are attached, can form a cycloalkyl orsubstituted cycloalkyl group; a is an integer from one to 8; providedthat when a is one, the A ring is a heterocyclic 6 to 12-membered ring;and when the A ring is a heterocyclic 5-membered ring, then a is aninteger from 2 to 8; each R³ is independently hydrogen, alkyl,substituted alkyl, aryl or substituted aryl; R⁵ is selected fromhydrogen, alkyl, substituted alkyl, aryl, substituted aryl, arylalkyl,substituted arylalkyl, heteroalkyl, substituted heteroalkyl, heteroaryl,substituted heteroaryl, heteroarylalkyl, and substitutedheteroarylalkyl; each R⁶ is independently selected from hydrogen, alkyl,substituted alkyl, aryl, substituted aryl, arylalkyl, substitutedarylalkyl, heteroalkyl, substituted heteroalkyl, heteroaryl, substitutedheteroaryl, heteroarylalkyl, and substituted heteroarylalkyl; b is anumber from zero to 100; and R⁷ is selected from hydrogen, alkyl,substituted alkyl, acyl, substituted acyl, alkoxycarbonyl, substitutedalkoxycarbonyl, aryl, substituted aryl, arylalkyl, and substitutedarylalkyl; or a salt, hydrate or solvate thereof; and a GI enzymeinhibitor that interacts with the GI enzyme that mediatesenzymatically-controlled release of the opioid from the opioid prodrugfollowing ingestion of the composition.
 112. The method of claim 111,wherein the GI enzyme is trypsin, and wherein the GI enzyme-cleavablemoiety is a trypsin-cleavable moiety, and wherein the GI enzymeinhibitor is a trypsin inhibitor.
 113. The method of claim 111, whereinthe opioid prodrug is of formula III:

wherein R^(a) is hydrogen or hydroxyl; R^(b) is hydrogen or alkyl; the Aring is a heterocyclic 5 to 12-membered ring; each Y is independentlyselected from alkyl, substituted alkyl, alkenyl, substituted alkenyl,alkynyl, substituted alkynyl, aryl, substituted aryl, acyl, substitutedacyl, carboxyl, alkoxycarbonyl, substituted alkoxycarbonyl, aminoacyl,substituted aminoacyl, amino, substituted amino, acylamino, substitutedacylamino, and cyano; c is a number from zero to 3; each R¹ isindependently selected from hydrogen, alkyl, substituted alkyl, alkenyl,substituted alkenyl, alkynyl, substituted alkynyl, aryl, substitutedaryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl, substitutedalkoxycarbonyl, aminoacyl, substituted aminoacyl, amino, substitutedamino, acylamino, substituted acylamino, and cyano; each R² isindependently selected from hydrogen, alkyl, substituted alkyl, alkenyl,substituted alkenyl, alkynyl, substituted alkynyl, aryl, substitutedaryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl, substitutedalkoxycarbonyl, aminoacyl, substituted aminoacyl, amino, substitutedamino, acylamino, substituted acylamino, and cyano; or R¹ and R²together with the carbon to which they are attached can form acycloalkyl or substituted cycloalkyl group, or two R¹ or R² groups onadjacent carbon atoms, together with the carbon atoms to which they areattached, can form a cycloalkyl or substituted cycloalkyl group; a is aninteger from one to 8; provided that when a is one, the A ring is aheterocyclic 6 to 12-membered ring; and when the A ring is aheterocyclic 5-membered ring, then a is an integer from 2 to 8; each R³is independently hydrogen, alkyl, substituted alkyl, aryl or substitutedaryl; R⁵ is selected from hydrogen, alkyl, substituted alkyl, aryl,substituted aryl, arylalkyl, substituted arylalkyl, heteroalkyl,substituted heteroalkyl, heteroaryl, substituted heteroaryl,heteroarylalkyl, and substituted heteroarylalkyl; each R⁶ isindependently selected from hydrogen, alkyl, substituted alkyl, aryl,substituted aryl, arylalkyl, substituted arylalkyl, heteroalkyl,substituted heteroalkyl, heteroaryl, substituted heteroaryl,heteroarylalkyl, and substituted heteroarylalkyl; b is a number fromzero to 100; and R⁷ is selected from hydrogen, alkyl, substituted alkyl,acyl, substituted acyl, alkoxycarbonyl, substituted alkoxycarbonyl,aryl, substituted aryl, arylalkyl, and substituted arylalkyl; or a salt,hydrate or solvate thereof.
 114. The method of claim 111, wherein theopioid prodrug is of formula VI:

wherein X is hydromorphone, morphine or oxymorphone; the A ring is aheterocyclic 5 to 12-membered ring; each Y is independently selectedfrom alkyl, substituted alkyl, alkenyl, substituted alkenyl, alkynyl,substituted alkynyl, aryl, substituted aryl, acyl, substituted acyl,carboxyl, alkoxycarbonyl, substituted alkoxycarbonyl, aminoacyl,substituted aminoacyl, amino, substituted amino, acylamino, substitutedacylamino, and cyano; c is a number from zero to 3; each R¹ isindependently selected from hydrogen, alkyl, substituted alkyl, alkenyl,substituted alkenyl, alkynyl, substituted alkynyl, aryl, substitutedaryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl, substitutedalkoxycarbonyl, aminoacyl, substituted aminoacyl, amino, substitutedamino, acylamino, substituted acylamino, and cyano; each R² isindependently selected from hydrogen, alkyl, substituted alkyl, alkenyl,substituted alkenyl, alkynyl, substituted alkynyl, aryl, substitutedaryl, acyl, substituted acyl, carboxyl, alkoxycarbonyl, substitutedalkoxycarbonyl, aminoacyl, substituted aminoacyl, amino, substitutedamino, acylamino, substituted acylamino, and cyano; or R¹ and R²together with the carbon to which they are attached can form acycloalkyl or substituted cycloalkyl group, or two R¹ or R² groups onadjacent carbon atoms, together with the carbon atoms to which they areattached, can form a cycloalkyl or substituted cycloalkyl group; a is aninteger from one to 8; provided that when a is one, the A ring is aheterocyclic 6 to 12-membered ring; and when the A ring is aheterocyclic 5-membered ring, then a is an integer from 2 to 8; each R³is independently hydrogen, alkyl, substituted alkyl, aryl or substitutedaryl; R⁵ is selected from hydrogen, alkyl, substituted alkyl, aryl,substituted aryl, arylalkyl, substituted arylalkyl, heteroalkyl,substituted heteroalkyl, heteroaryl, substituted heteroaryl,heteroarylalkyl, and substituted heteroarylalkyl; each R⁶ isindependently selected from hydrogen, alkyl, substituted alkyl, aryl,substituted aryl, arylalkyl, substituted arylalkyl, heteroalkyl,substituted heteroalkyl, heteroaryl, substituted heteroaryl,heteroarylalkyl, and substituted heteroarylalkyl; b is a number fromzero to 100; and R⁷ is selected from hydrogen, alkyl, substituted alkyl,acyl, substituted acyl, alkoxycarbonyl, substituted alkoxycarbonyl,aryl, substituted aryl, arylalkyl, and substituted arylalkyl; or a salt,hydrate or solvate thereof.